Food and Nutrition Needs

UNHCR UNICEF WFP WHO in Emergencies

Printed: November 2002 — Cover Photo: WFP/C. Shirley

UNITED NATIONS UNITED NATIONS WORLD WORLD
HIGH COMMISSIONER CHILDREN'S FOOD HEALTH
FOR REFUGEES FUND PROGRAMME ORGANIZATION
94, Rue de Montbrillant, Unicef House, Via C. G. Viola, 68/70 20, Avenue Appia
1202 Geneve 3 UN Plaza, 00148 Rome, CH - 1211 Geneva 27
Switzerland New York, NY 10017, USA Italy Switzerland
E-mail: E-mail: E-mail: E-mail:
hqts00@unhcr.ch nutritioninfo@unicef.org wfpinfo@wfp.org nutrition@who.int
Web site: Web site: Web site: Web site:
www.unhcr.ch www.unicef.org www.wfp.org www.who.int/nut

Food and Nutrition Needs in Emergencies

UNHCR UNICEF WFP WHO

FOREWORD

UNHCR, UNICEF, WFP and WHO have jointly developed these

guidelines as a practical tool for assessing, estimating and monitoring
the food and nutrition needs of populations in emergencies.

Major food shortages can be a primary feature of an emergency,

as in droughts or floods that lead to famine, or they may be a consequence
of war, economic disaster, or population displacement. The often serious
protein-energy malnutrition and micronutrient deficiencies that inevitably
follow such shortages add greatly to the burden of disease and mortality,
slow - or even impede altogether - socioeconomic recovery, and make
intense additional demands on scarce resources.

The guidelines are aimed at field staff involved in planning and delivering
a basic general food ration for emergency-affected populations. Their
overall aim is to promote timely, coordinated and effective action through
improved understanding of food and nutrition needs during emergencies.

Graeme A. Clugston
Director, Nutrition for Health and Development
World Health Organization
Geneva, Switzerland
CONTENTS

LIST OF ABBREVIATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IV

PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

CONTEXT AND PURPOSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

OVERVIEW OF APPROACH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

BASIC PRINCIPLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

PLANNING A RATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
I. THE INITIAL PLANNING FIGURE FOR ENERGY ............................................................................................... 7

II. ADJUSTING THE INITIAL PLANNING FIGURE FOR ENERGY ............................................................................. 7

A. Environmental Temperature ................................................................................................................ 7
B. Health and Nutritional Status .............................................................................................................. 7
C. Demographic Characteristics .............................................................................................................. 8
D. Physical Activity Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

III. CHOOSING COMMODITIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

A. Macronutrient (Protein and Fat) Requirements ..................................................................................... 8
B. Acceptable Basic Rations ................................................................................................................... 9
C. Refining the Ration: Selecting Commodities to Meet Specific Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
1. Addressing Micronutrient (Vitamin and Mineral) Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
a. Micronutrient Adequacy in a Ration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
b. Micronutrient Deficiencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
c. Fortification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
d. Strategies to Prevent Micronutrient Deficiencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
e. Health Measures and Micronutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
D. Adjusting the Ration According to People's Access to Food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
1. Emergency Food Needs Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
2. Calculating Food Requirements Based on Access to Food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
E. Meeting the Special Nutritional Needs of the Most Vulnerable Persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
1. Infants and Young Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
a. Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
b. Breastfeeding and HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
2. Complementary Feeding for Older Infants and Young Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
3. Pregnant and Lactating Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
4. Older Persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
F. Use of Special Commodities: Milk Powder and Ready-to-Eat Meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
1. Milk Powder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
2. Ready-to-Eat Meals, Emergency Rations and High-Energy Biscuits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

II
IV. FACTORS AFFECTING FOOD PROCESSING, PREPARATION AND USE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
A. Local Food Habits and Cultural Acceptability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
B. Milling Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
C. Fuel for Food Preparation ................................................................................................................. 26
D. Non-Food Items Required for Food Preparation .................................................................................. 26

V. MANAGEMENT OF FOOD-RELATED ISSUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

A. Temporary Substitution of Food Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
B. Packaging of Food-Aid Commodities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
C. Exchange and Trade of Rations ......................................................................................................... 28
D. Quality Control ................................................................................................................................. 29

MONITORING AND FOLLOW-UP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

I. MONITORING MECHANISMS TO ASSESS THE ADEQUACY OF THE RATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

II. MONITORING TOOLS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

III. FOLLOW-UP TO MONITORING ................................................................................................................... 32

IV. ACCESS TO OTHER SOURCES OF FOOD IN POST-EMERGENCY PHASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

A. Assessing Food and Nutritional Needs in Post-Emergencies ................................................................ 33
B. Supporting Recovery ........................................................................................................................ 34

V. SELF-RELIANCE AND EXIT STRATEGIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

FURTHER READING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

TABLES:
1: Emergency Phases and Planning .............................................................................................................. 3
2: Examples of Adequate Full Rations in Terms of Energy, Protein and Fat
for Populations Entirely Reliant on Food Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
3: Daily Requirements of Vitamins and Minerals for a Population Needing
Emergency Food Aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
4: WFP Fortification Specifications for Selected Commodities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
5: Response Options to Address Micronutrient Needs ................................................................................ 14
6: Options for Addressing Nutritional Needs of Older Infants and Young Children ..................................... 20
7: Challenges and Implications for Planning Food Needs for Older Infants and Young Children .................. 21
8: Complementary Interventions to Meet the Additional Needs of Pregnant and Lactating Women ............ 22
9: Considerations to the Nutritional and Food Needs of Older Persons ....................................................... 23
10: Advantages and Disadvantages of Ready-to-Eat Meals and Humanitarian Daily Rations .......................... 25
11: Tools and Types of Information Required for Monitoring Adequacy of Rations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
12: Examples of Strategies for Addressing Problems Documented by Monitoring ........................................... 32
13: Principles for Estimating Food and Nutritional Needs in Post-Emergencies ............................................. 33

III
ANNEXES:
1: Energy Requirements for Emergency-Affected Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
2: Vitamin and Mineral Requirements—Safe Levels of Intake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
3: Nutritional Value of Commonly Used Food-Aid Commodities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
4: Micronutrient Content of Selected Food-Aid Commodities .............................................................. 41
5: Example of How to Calculate the Percentage Energy of Protein and Fat in a Ration . . . . . . . . . . . . . . . . . . . . . . . . . .42
6: Example of How to Calculate the Micronutrient Content of a Ration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
7: Blended Foods: Requirements and Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
8: Examples of Blended Foods with Characteristic Preparations and Micronutrient Contents . . . . . . . . . . . . . . . . .45
9: Policies and Guidelines to Protect, Support and Promote Breastfeeding
and Good Infant Feeding Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
9a: Policy for Acceptance, Distribution and Use of Milk Products in Refugee Operations . . . . . . . . . . . . . . . . . . . . . . . .46
9b: Baby- Friendly Hospital Initiative: Ten Steps to Successful Breastfeeding .......................................... 46
9c: Practical Steps to Ensure Appropriate Infant and Young Child Feeding in Emergencies ..................... 47
10: Calculated Amounts of Basic Mixes of Staples and Protein-Rich Foods for Complementary Foods ..... 49
11: Nutritional Requirements for Pregnant and Lactating women in Developing Countries ..................... 50
12: Conceptual Framework .................................................................................................................... 51

LIST OF ABBREVIATIONS

BMI body mass index HDR humanitarian daily ration

BMR basal metabolic rate HEM high-energy milk
BMS breast milk substitute IBFAN International Baby Food Action
CMR crude mortality rate Network
DSM dried skim milk MoU Memorandum of Understanding
DWM dried whole milk MRE meals ready to eat
ENN Emergency Nutrition Network NGO Non-Governmental Organisation
FBM food basket monitoring PAL physical activity level
GIFA Geneva Infant Feeding Association TM therapeutic milk

IV
PREFACE
According to the Universal Declaration
of Human Rights (UDHR) Article 25(1),
“everyone has the right to a standard of living
adequate for the health and well-being of himself
and of his family, including food… ”. In
emergency contexts, it is important to reaffirm
the fundamental right of everyone to have
access to adequate and safe food. The
Humanitarian Charter and the Minimum
Standards (1998)1 aim to quantify people’s
requirements for water and sanitation, food
and nutrition, shelter and health care. Taken
together, the Humanitarian Charter and the
Minimum Standards contribute to an
operational framework for accountability
in diverse humanitarian assistance efforts.
Food supply should be adequate to cover the
overall nutritional needs of all population
groups in terms of quantity, quality and safety.
In emergency situations, where populations are
dependent on food assistance, an “adequate
food ration” meets the population’s minimum
energy, protein and fat requirements for
survival and light physical activity. An
adequate food ration is also nutritionally
balanced, diversified, culturally acceptable,
fit for human consumption and suitable
for all sub-groups of the population.
Because micronutrient deficiencies are
common worldwide—and endemic in many
developing countries—rations should provide
adequate micronutrients (vitamins and
minerals), where possible, particularly for
populations entirely dependent on food aid.
1 Humanitarian Charter and Minimum Standards in Disaster Response. The Sphere Project. Geneva, 1998.
2 Light PAL defined as 55 percent above the basal metabolic rate (BMR) for males and 56 percent above the BMR for females.
1
For planning purposes, the World Health
Organization (WHO) and the U.S.
Committee on International Nutrition
recommend that an average of 2,100 kcal per
person/per day be used as an initial planning
figure. This estimate covers the energy needs
of a typical population in a developing country,
assuming a standard population distribution,
body size, ambient temperature, pre-emergency
nutritional status and light physical activity
level (PAL).2 Since implementation of revised
Memoranda of Understanding (MoUs)
(UNHCR/WFP, July 2002; WFP/UNICEF,
February 1998), the three agencies have
adopted 2,100 kcal as their initial planning
figure for calculating energy requirements
and designing food rations.
The process of tailoring food requirements
for a specific population requires a number
of considerations. The initial planning figure
for energy should be adjusted according to
environment, demographic and physiological
criteria specific to the affected population.
Food commodities are then selected to meet
basic nutritional requirements. Finally, other
factors are considered to ensure that the ration
is appropriate to all population sub-groups,
such as infants and young children, pregnant
and lactating women and the older persons.
Food-management aspects and the underlying
preconditions for ensuring adequate nutrition
(such as the social and health situation
or environmental issues) are also considered
when estimating food and nutritional needs
in emergencies.
CONTEXT AND PURPOSE

Close collaboration between the agencies The purpose of these guidelines is to provide
of the United Nations is essential for an practical tools for estimating food and
effective emergency response. In order nutritional needs of populations in emergency
to facilitate this collaboration, Memoranda situations. In particular, these goals include to:
of Understanding have been signed by several
United Nations agencies; these agreements • provide practical operational guidelines
aim to clarify roles and responsibilities for United Nations3 and other agency staff
in emergency relief and rehabilitation involved in planning a basic general food
programmes, and outline commitments ration for emergency situations;
to joint activities within agency
competencies. • estimate the food and nutritional needs
for vulnerable groups;

• provide a clear outline of the main factors

to take into consideration when planning
an adequate ration; and

• provide a framework for training activities

and/or supporting ongoing training
activities related to planning food
assistance.

3 The guidelines are based on the recommendations of the relevant technical United Nations agencies,
specifically WHO and the Food and Agriculture Organization (FAO).

2
OVERVIEW OF APPROACH
Table 1, below, provides an overview of the
two characteristic phases4 of an emergency
response. During the first phase of the
emergency (Phase I), the initial planning
figure for energy is used and adjusted
according to available information at the
outset of the emergency as food-management
and -monitoring systems are established.
Later on, in Phase II, when the situation
is stabilized, the initial planning figure
Table 1: Emergency Phases and Planning
PHASE I OF THE EMERGENCY
From the outset and during initial
stages of the emergency
(i.e. during initial rapid assessments)
PHASE II OF THE EMERGENCY
Situation stabilized
4 For the purpose of this document, the “phase” of the emergency refers to the context-specific
time frame in relation to the emergency response.
for energy is further revised based on
changing circumstances during periodic
reassessment exercises. It is during these
periodic reassessments that strategies
for continued assistance and/or phase-out
activities are planned. The “Planning
a Ration” section of the guidelines
(pages 6-29) summarizes the basic principles
for the design of an adequate ration
in emergency situations.
➪ Adopt 2,100 kcal/person as a reference figure.
➪ Adjust the 2,100 kcal figure based on information available immediately,
using the factors outlined in Section II (pages 7-8).
➪ Ensure that food ration is adequate to address the protein,
fat and micronutrient requirements of the population.
➪ Ensure that food ration is adequate to address the nutritional needs
of all sub-groups of the population.
➪ Outline strategies for collecting information to make further adjustments.
➪ Consider food-management issues.
➪ Consider food-related conditions.
➪ Establish a monitoring system to ensure adequacy of the ration.
➪ Through periodic reassessment, further revise and adjust the reference
figure based on additional information about all the factors affecting
energy requirements specific to the situation.
➪ Plan for longer-term assistance or phase-down and phase-out strategies.
3
BASIC PRINCIPLES
• A coordinated approach: Responding
to the nutritional needs of an emergency-
affected population requires a commitment
to a coordinated approach among all
the key actors: United Nations agencies,
bilateral donors, the Government, NGOs,
and the community, women in particular.
• Context-specific assistance: Food-assistance
programmes that meet the needs of affected
populations in emergencies must be based
on a clear understanding of the situation.
An analysis of the specific context and its
nutritional problems and an understanding
of the causes and potential risks
of malnutrition are required.
4
• A general food basket based on providing
2,100 kcal per person per day: Individual
energy requirements are estimated for
different population groups according
to age, gender, weight and physical activity
level. The mean per capita energy
requirement for a population has been
calculated by taking the weighted-average
requirements for each age-sex group (see
Annex 1). The mean per capita energy
requirement is not specific to any age
or sex group and should therefore not
be considered as the requirement
of a particular individual. The estimate
of 2,100 kcal/person/day was also designed
to include the needs of pregnant and
lactating women within the population.
• Timely distribution of an adequate, basic
ration: At the onset of an emergency,
ensuring an adequate basic ration for the
needy population is crucial. The quick
provision of an adequate ration not only
saves lives, but also reduces the likelihood
of later having to introduce more costly
and cumbersome interventions such
as selective feeding programmes.
• A standard food ration: In a general food • Monitoring, adjusting and targeting:
distribution, a standard food ration5 Monitoring mechanisms must be in place
is provided to every beneficiary without to assess the adequacy of the established
distinction. Population sub-groups with ration, to adjust the ration according
obvious additional nutritional requirements to changing circumstances and to target
(e.g. malnourished children) may require sub-populations at relatively higher risk
an additional ration over and above on the basis of food need and/or
the standard basic ration. vulnerability to food insecurity. A strategy
for monitoring the adequacy of a ration
requires the use of a number of different
quantitative and qualitative tools
• Community participation: To meet the food (e.g. joint food assessment missions,
and nutritional needs of the population vulnerability analysis and mapping [VAM],
more effectively, the planning of the household food economy assessments).
food ration should be carried out with the An understanding of the various
participation of the affected community. mechanisms used by the population
Women in particular should be consulted to access food, including an analysis of
during the process of determining the the positive and potentially negative
appropriate food and nutritional needs implications of any coping mechanisms,
of the affected population. is essential. Understanding such
mechanisms improves food and nutritional
estimates and may contribute to helping
populations achieve self-reliance.

5 A food ration that covers the daily per capita energy requirement (2,100 kcal)
and is adjusted for the population under consideration.

5
PLANNING A RATION

The box below is an overview of the process
necessary to estimate food and nutritional
needs in emergency situations. Following
adoption of the initial planning figure of
2,100 kcal/person/day, adjustments are made
based on factors such as temperature, health
or nutritional status of the population,
demographic distribution of the population
and activity levels. These points should be
revisited as part of the monitoring process
as more information becomes available
through assessments.

1. Calculate the energy requirements of the population.

The initial planning figure or energy requirement is 2,100 kcal/person/day.

Adjust this upward or downward based on the following four issues:

If the temperature is below 20° C, adjust energy requirements upward

TEMPERATURE
by 100 kcal for every 5° below 20° C (page 7).

HEALTH OR NUTRITIONAL If either of these is extremely poor, adjust the energy requirements
STATUS OF THE POPULATION upwards by 100–200 kcal (page 7).

DEMOGRAPHIC DISTRIBUTION If the demographic distribution is not normal, there may be a need to
OF THE POPULATION adjust the energy requirements upwards or downwards (page 8).

If the population is engaging in medium to heavy activities, there may

ACTIVITY LEVELS
be a need to adjust the energy requirements higher (page 8).

2. Select commodities that meet the energy, protein, fat and micronutrient requirements
of the population (from page 8).

3. Implement monitoring and follow-up actions, data collection and analysis (from page 30).

4. If necessary, assess the ability of the population to access other food sources and adjust the
ration. Monitor the situation following any such adjustments (page 33).

6
I. THE INITIAL PLANNING FIGURE
FOR ENERGY
The average estimated daily per capita energy
requirement of 2,100 kcal is used to expedite
decisions about the immediate initial
provision of food (see Annex 1 for details on
calculation of the initial planning figure).
It is important that this figure be adjusted
when necessary, according to the factors
outlined in the next section.
II. ADJUSTING THE INITIAL
PLANNING FIGURE FOR ENERGY
Four main factors should be taken
into consideration when making decisions
to adjust the initial planning figure for energy.
These include environmental temperature,
and the population’s health and nutritional
status, demographic characteristics,
and physical activity level.
A. Environmental temperature
A cold environment increases an individual’s
energy expenditure—especially if shelter,
clothing and/or heating are inadequate.
Current convention uses an average
temperature of 20ºC as a base, adding an
allowance of 100 kcal for every 5º below
20ºC as shown in the box below.
Adjustments to energy requirement mean
daily temperature
20° C
15° C
10° C
5° C
0° C
Source: The management of nutrition in major emergencies. WHO. Geneva, 2000.
6 For more detailed information on measuring malnutrition, z-scores and CMR, please consult “The management of Nutrition in Major Emergencies.”
WHO, Geneva, 2000 and the “Food and Nutrition Handbook,” WFP, 2000.
Practical examples:
• The average temperature from November
to February in Kosovo is 5–10°C. During
these winter months, the initial planning
figure for energy should be adjusted upwards
by 200–300 kcal (i.e. 2,300–2,400 kcal
for the whole population).
• The average temperature from December-
March in Afghanistan and North Korea is
below 0°C. During these winter periods,
the initial planning figure for energy should
be adjusted upwards by 300-500 kcals.
B. Health and nutritional status
Energy requirements increase during periods
of nutritional rehabilitation and recovery
from severe illness, requiring an upward
revision of the ration level. For example, such
a revision would be required for a population
that has suffered severe prolonged food
shortages that caused high levels of
malnutrition. Another example would be
a population affected by a widespread
epidemic. Provision of 2,100 kcal may be
sufficient to permit catch-up growth for
children with pre-existing malnutrition,
but is inadequate to restore the body weight
of a malnourished adolescent or adult.
An additional 100–200 kcal should be added
to the basic ration in extreme situations,
when the nutritional status of the population
is extremely poor or when the crude mortality
rate (CMR) is significantly elevated.
For example, when the prevalence
of malnutrition among children under 5 years
—
of age is high (i.e. more than 15 percent
+100kcal <-2 z-score weight-for-height) and
+200kcal
+300kcal the CMR is high (i.e. CMR higher than
+400kcal
2/10,000 per day).6
7
 Practical example:
In a refugee camp, the crude mortality rate
(CMR) dramatically increases (from five-
to tenfold) above a baseline death rate
of 0.7/10,000 persons per day. The prevalence
of malnutrition among under-5-year-olds is
24 percent (<-2 z-score weight-for-height).
Further epidemic outbreaks are a threat as a
result of the overcrowding and extremely poor
sanitation conditions in the camps. The
provision of at least an additional 100 kcal per
day above the initial planning figure for the
whole population in combination with other
measures is appropriate (i.e. at least 2,200 kcal).
C. Demographic characteristics
The composition of the population affects
the average energy requirement. For pragmatic
reasons, a standard demographic profile is used,
since it can be difficult to obtain accurate
demographic information on the emergency-
affected population (Annex 1). Later,
demographic data on the affected population
can be collected through a census or from
survey data. Adjustments in energy
requirements are made thereafter where there
are significant deviations from the reference
standard.7
Practical example:
In a refugee camp, the affected population
comprise predominantly adolescent boys
(over 80 percent). The average energy
requirement for adolescent boys (10–19 years
old) is 2,300–2,700 kcal. Under these
circumstances, it is appropriate to adjust
the initial planning figure upwards
by an amount of 300 kcal per day
(i.e. 2,400 kcal for the whole population).
7 The “adjusted” energy requirement is calculated by substituting the relevant age/sex proportions of the specific population
and re-calculating the weighted average.
8
D. Physical activity level
The physical activity level affects energy
expenditure. The basal metabolic rate is
defined as the amount of energy necessary
to maintain normal body functions at rest.
The average minimum energy requirement
of 2,100 kcal is based on both the BMR
and additional energy requirements associated
with a “light” PAL. In other words, 2,100 kcal
will maintain the health and nutritional
status of an individual engaged in light work.
In situations where the affected population
is engaged in moderate or heavy work,
an increase in ration should be considered.
Moderate and heavy workloads would
include, for example, a population that
is walking long a distance to collect water
and fire wood or constructing houses.
III. CHOOSING COMMODITIES
With the initial planning figure (2,100 kcal)
in mind, food commodities that meet the
basic energy, protein, fat and micronutrient
requirements of the affected population must
first be selected. An acceptable ration also
takes into consideration local dietary
preferences.
A. Macronutrient (protein and fat)
requirements
Energy needs are usually met through a range
of commodities with ample protein content
(cereal, blended food, pulses). In line with
FAO/WHO technical reports, protein should
provide at least 10–12 percent of total energy.
The requirements of a population can be
readily satisfied with mixtures of proteins B. Acceptable basic rations
of plant origin (e.g. cereals and legumes). Table 2 presents five examples of rations8
that meet minimum energy, fat and protein
At least 17 percent of energy in the ration requirements. The energy, protein, fat,
should be provided in the form of fat. and micronutrient contents of a ration
However, with particular reference can be readily calculated using the nutritional
to supplementary feeding programmes, composition tables in Annexes 3 and 4.
fat requirement for young children An example of how to calculate the energy,
is between 30-40 percent of their energy protein and fat content of a typical ration
requirements, and pregnant and lactating is given in Annex 5.
women at least 20 percent.

Table 2: Examples of adequate full rations in terms of energy, protein and fat
for populations entirely reliant on food assistance
ITEMS RATIONS
(quantity in g)

Example 1 Example 2 Example 3 Example 4 Example 5

Cereal 400 450 350 400 400

Pulses* 60 60 100 60 50
Oil (vit. A fortified) 25 25 25 30 30
Fish/meat - 10 - 30 -
Fortified blended foods 50 40 50 40 45
Sugar 15 - 20 - 25
Iodized salt 5 5 5 5 5

Energy: kcal 2,113 2,075 2,113 2,146 2,100

Protein (in g and in % kcal) 58 g; 11% 71 g; 13% 65 g; 12% 55 g; 10% 65 g; 12%
Fat (in g and in % kcal) 43 g; 18% 43 g; 18% 42 g; 18% 42 g; 17% 39 g; 17%

* Not all types of pulses are acceptable to all populations; therefore, the most familiar type of pulse must be resourced for the population.

8 The different types of rations are determined by factors such as the food habits of the population,
the acceptability and the availability of commodities.

9
 CHECKLIST
FOR ADJUSTMENTS TO THE INITIAL PLANNING FIGURE OF 2,100 KCAL

✔ Are the majority of the population undertaking strenuous physical activities such as
carrying heavy loads over long distances?
✔ Is the average temperature significantly lower than 20°C?
✔ What is the prevalence of malnutrition among the population?
✔ Is the CMR significantly higher than normal?
✔ Are there significant public health risks for the affected population?
✔ Is the demographic profile of the affected population similar to the average
for a developing country?
✔ Is the population receiving a regular supply of some food from other sources?
✔ What is the percentage of energy from protein in the ration?
✔ Is the energy obtained from fat at least 17 percent?

C. Refining the ration: Selecting 4. Underlying social and cultural issues

commodities to meet specific
considerations
Once the per capita daily nutrient
requirements have been established, and basic
food commodities identified, the ration
is refined to ensure that other specific
requirements are covered. The main
considerations for the type and quality
of foods being provided in the basic
rations are:
1. Micronutrient requirements
(potential deficiencies and the need
for provision of fortified blended foods)
2. Special nutritional requirements
for the more vulnerable: infants and
young children, pregnant and lactating
women, and older persons
3. Use of exceptional commodities:
milk powder and ready-to-eat meals
affecting food use and food preparation
5. Logistics and food-management
practicalities
1. Addressing micronutrient (vitamin
and mineral) requirements
The adverse effects of micronutrient
deficiencies are profound. Micronutrient
deficiencies may lead to increased risk
of death, morbidity and susceptibility
to infection, blindness, adverse birth
outcomes, growth stunting, low work
capacity, decreased cognitive capacity and
mental retardation. In emergency
situations, the affected population may
have suffered endemic micronutrient
deficiencies, often exacerbated by a general
deterioration in nutritional status,
a limited access to fresh foods, a loss
of access to traditional foods and
a lack of food diversity.

10
a. Micronutrient adequacy in a ration likelihood of micronutrient-deficiency
Determining the micronutrient adequacy of diseases, including:
a ration requires a straightforward comparison
of the population’s daily micronutrient • endemic micronutrient deficiencies
requirements with the estimated level in the country of origin;
of micronutrients in the basic ration. • lack of suitable diversification in rations
(e.g. only one or two commodities are
Table 3 provides a summary of the safe levels provided);
of some vitamins and minerals. Intakes below • lack of access to fresh foods;
these levels may result in vitamin deficiencies • rations based on highly refined cereals
and other nutrition-related problems among that may be low in B vitamins,
the population. A more detailed description iron, potassium, magnesium and zinc; and
of requirements for specific vitamins and • high rates of infection and/ or diarrhoea
minerals by age is found in Annex 2. in children.

The micronutrient content of a ration Iron deficiency anaemia, vitamin A

can be calculated using the nutrient content deficiency and iodine deficiency are
of the food ration using the nutritional recognized as the three most significant
composition data of selected foods shown micronutrient-deficiency diseases worldwide.
in Annex 4. The process of determining Given the endemic aspect of these diseases
whether the micronutrient content of a ration in some developing countries, they are
may be too low is described in Annex 6. to be expected among a food-insecure
population unless appropriate action is
b. Micronutrient deficiencies taken. Other micronutrient-deficiency
Populations that are highly dependent diseases, including scurvy (vitamin C
on food assistance are often at risk deficiency), pellagra (niacin deficiency)
of micronutrient-deficiency diseases. Efforts and beriberi (thiamine deficiency) have
should be made within the context re-emerged among emergency-affected
of emergency food assistance programmes populations during the past
to recognize factors that increase the two decades.

Table 3: Daily requirements of vitamins and minerals for a population needing

emergency food aid
VITAMIN/MINERAL RECOMMENDED DAILY INTAKE
Vitamin A 500 µg retinol equivalents (or 1,666 IU)
Thiamine (B1) 0.9 mg
Riboflavin (B2) 1.4 mg
Niacin 12.0 mg
Folic acid 160 µg
Vitamin C 28.0 mg
Vitamin D 3.8 µg
Iron 22 mg*
Iodine 150 µg

* Assuming low bio availability of iron in the diet (i.e. 5-9%) — Source: The management of nutrition in major emergencies. WHO, Geneva, 2000.

11
c. Fortification
The inclusion of a fortified blended food—
an effective vehicle for a number
of micronutrients—is an important part
of the basic ration in an emergency situation,
particularly for the micronutrient needs
of young children, pregnant and lactating
women, and the elderly. Blended foods must
meet certain criteria in terms of composition
and micronutrient fortification (see Annex 7).
Food fortification is the process whereby
one or more nutrients (vitamins or minerals)
are added to foods during processing. These
Vegetable oil
Salt
Wheat and maize flour
Blended foods
12
micronutrients are essential for human
growth, natural immunity and development.
Fortification does not greatly increase
the cost of food or adversely affect its
taste and acceptability.
A single fortified food commodity
is not a practical vehicle for the delivery of
all essential micronutrients. Rather,
different foods should be fortified with the
appropriately matched micronutrient(s).
For example, the following box shows
foods with mandatory fortification
requirements:
Vitamin A and D
Iodine
Vitamin A, thiamine (B1), riboflavin (B2), niacin, folic
acid and iron
Vitamin A, thiamine (B1), riboflavin (B2), niacin, folic
acid, vitamins C and B12, iron, calcium and zinc
WFP fortification specifications for vegetable oil, salt, wheat and maize flour,
and blended foods follow in Table 4.

Table 4: WFP fortification specifications for selected commodities

COMMODITY VITAMINS AND/OR MINERALS FORTIFICATION QUANTITY
Vegetable Oil Vitamin A 30,000 IU/kg oil or
9,000 µg RE Vitamin A /kg oil
Vitamin D 3,000 IU per kg oil or
75 µg Vitamin D per kg oil
Salt Iodine 20–40 mg of iodine /kg salt
or 33–66 mg of potassium
iodinate per kg salt
Wheat and maize flour* Vitamin A 10,000 IU per kg flour
Thiamine (B1) 4.4 mg per kg flour
Riboflavin (B2) 2.6 mg per kg flour
Niacin 35 mg per kg flour
Folic Acid 0.4 mg per kg flour
Iron 29 mg per kg flour
Blended foods See Annex 8 for recommendations See Annex 8 for recommendations

* Fortification levels may be adjusted according to national requirements.

d. Strategies to prevent micronutrient public health measures is frequently necessary

deficiencies to eliminate (or prevent) a specific
Providing fortified blended food is one micronutrient deficiency. Two examples
strategy to correct or prevent micronutrient of public health measures are: deworming
deficiencies in an emergency situation. interventions in combination with
It is described along with several other distribution of iron supplements to control
strategies in Table 5. iron deficiency anaemia, and distribution
of vitamin A capsules through routine
e. Health measures and micronutrients supplementation to control vitamin A
Combining the above nutritional deficiency and to reduce overall morbidity
interventions with other complementary and mortality.

13
Table 5: Response options to address micronutrient needs
STRATEGY
1. Inclusion of fortified food
items in the general ration
2. Promoting the production
of vegetables and fruit
3. Promoting beneficial
food-preparation practices
4. Providing fresh food items
in general ration
(or facilitating access
to fresh foods)
5. Food diversification:
adding to the ration a food
rich in a particular vitamin
or mineral( e.g. ground
nuts, dried fish).
6. Distribution of
vitamin/mineral
supplements
STRENGTHS
- Reaches a large number
of recipients.
- Interventions can be
implemented rapidly.
- Cost effective.
- Supports self-reliance.
- Provides fresh foods
of preferred choice.
- May support indigenous
food-preparation practices
in some situations.
- Improves palatability and
quality of ration.
- Reaches a large number
of recipients.
- Interventions can be
implemented rapidly.
- Can be very effective
if linked with immunizations
or health programmes
(e.g. vitamin A).
14
WEAKNESSES
- Limited to food-aid
commodities that are
suitable vehicles for
micronutrients.
- Need to be sustained until
access to fresh food
improves.
- Requires population to have
access to land, water and
agricultural inputs.
- Introduced practices may
be unfamiliar to the
population and therefore
require substantial
communications.
- Expensive and logistically
difficult.
- May increase market prices
at local or regional level.
- Feasibility of providing for
whole population unlikely.
- Needs to be sustained until
access to fresh food
improves.
- Food safety and quality
control can be difficult
- Distribution system needs
to be maintained.
- May be expensive and
time-intensive if relying
on an independent
distribution system.
REMARKS/
EXAMPLES
- Oil with vitamin A, fortified
flours.
- Requires active
participation of the food
industry and donor.
- Need to ensure fortification
specifications are met
(quality control).
- Cultivation of homestead
gardens or communal
garden plots.
- Fermentation, sprouting
grains and pulses.
- Fresh foods provided must
be rich in micronutrient(s).
- Restricted to foods that
the population is familiar
with and that contain the
relevant micronutrients.
- Distribution of some
specific micronutrient
supplements such as
vitamin C may be better
suited to treatment
rather than preventive
measures.

C H E C K L I S T:
DOES THE FOOD BASKET
MEET MICRONUTRIENT
REQUIREMENTS?
✔ Is the ration likely to be deficient
in a specific micronutrient(s)?
Why?
✔ Was/is there an endemic
micronutrient deficiency
in the population? If so, can
a large-scale preventive intervention
be considered through the
general ration?
✔ Are food-aid commodities
in the ration appropriately fortified?
✔ Are additional interventions such
as home gardens, health promotion
and deworming programmes
appropriate and feasible?
15
D. Adjusting the ration according
to people's access to food
1. Emergency food needs assessments
There is a variety of methods and analytical
frameworks that can be used to assess
the ability of populations to access food
on their own. While there is currently
no universally agreed-upon method for
conducting emergency food needs
assessments, the broad goal of such
assessments is to understand the different
ways that people are able to obtain food
through their own activities. Information
gathering should use qualitative and
quantitative methods and should include
data from both primary and secondary
sources. A number of useful sources
on emergency food needs assessments
are listed on page 16.
Emergency food needs assessments should be
conducted keeping in mind the overall goals
and operational objectives of food assistance.
These objectives would normally include
one or more of the following:
• to save lives;
• to maintain or improve health/nutritional
status with special attention to pregnant
and lactating women and other groups
at high risk;
• to preserve productive assets;
• to prevent mass migration;
• to ensure access to a adequate diet
for all population groups;
• to establish conditions for and promote
rehabilitation and the restoration
of self-reliance; and
• to minimize damage to food-production
and -marketing systems due to the
emergency situation.
2. Calculating food requirements based the board may mean that a significant
on access to food proportion of the population receives
At the onset of sudden emergencies, such as insufficient food to meet its needs.
refugee influxes, floods and hurricanes,
populations typically have no access to food
other than that provided through relief Sources of information:
programmes. In these types of situations,
it is generally appropriate to estimate the The information that is required
food requirements for humanitarian assistance to make decisions about the ration
based on the adjusted energy requirements should be based on a demonstrated
for the population (i.e. provide a full ration understanding of the situation.
calculated using the adjusted planning figure). It is usually collected from the
following sources:
In situations where an emergency food needs
assessment has determined that a population • background information on the
is able to obtain food through activities9, country (e.g. demographics and
it may be appropriate to adjust the food climate);
requirements for a population to reflect
this fact. In practice, this must be done with • formal assessments and primary data
extreme caution, as most estimates of the from quantitative surveys and
ability of people to provide for their own qualitative sources;
food needs are fairly crude. Typically, the
proportion of energy requirements that • the community and other key
the population can provide is estimated informants (e.g. village leaders,
to the nearest increment of 25 percent community representatives and
(i.e. 25 percent, 50 percent, 75 percent). women); and
For example, if the energy requirements
for a given population have been calculated • secondary sources of information
at 2,100 kcals, and an assessment has (e.g. country profiles and
determined that the population has the project/programme reports).
capability to provide about 25 percent of their
daily energy requirements (about 500 kcals),
the food assistance should be calculated
to provide 1,600 kcals. It is important
to continue to monitor indicators
of nutritional status, food security and coping
strategies after adjustment of rations to ensure
that the ration reduction is not having
adverse effects. Reducing the ration across

9 Such a decision should also weigh whether the activities

are damaging or unsustainable.

16
E. Meeting the special nutritional needs in emergencies. Artificial feeding in these
of the most vulnerable persons circumstances increases the risk of diarrhoeal
diseases and malnutrition, which in turn
1. Infants and young children10 substantially increases the risk of infant death.
Experience has shown that infant and child If absolutely required, infant formula should
morbidity and mortality rates often only be used when all other options (e.g.
dramatically increase during emergencies. wet-nursing) have been exhausted11. For these
Malnutrition during the early years of life reasons, infant formula should only be
has a negative impact on cognitive, motor-skill, purchased and distributed based on needs
physical, social and emotional development. As assessments carried out by adequately trained
part of estimating food and nutritional needs, nutrition and health workers. Strategies should
specific interventions are required during also be developed to promote best practices
emergencies to protect and promote optimal in situations where formula is used. If used,
infant- and child-feeding practices. These infant formula should have generic labelling
interventions should be routinely included in as well as reconstitution instructions in the
any relief response and should be sustained local language. See box on the next page
throughout the period of response. on guiding principles for feeding infants
during emergencies.
a. Breastfeeding
Breast milk is the ideal food for healthy growth Supplementary feeding may be an important
and development of infants and young intervention for protecting the nutritional
children. The availability of nutrients from status of the lactating mother and maintaining
breast milk exceeds that from any other the nutritional quality of the breast milk.
substitute. Breast milk not only provides all the Support and encouragement may also be
nutrient requirements for infants but also required to maintain and enhance breastfeeding
protects children from infection. The practice in individuals affected by high levels
of exclusive breastfeeding for the first six of psychological stress.
months of life can also provide a contraceptive
effect for the mother, who is spared the UNHCR, UNICEF, WFP and WHO comply
depleting effects of closely spaced pregnancies. with the international guidelines on the
In addition, breastfeeding enhances bonding protection and promotion of breastfeeding.
between mother and child, providing crucial All staff involved in the planning of food
physical and emotional support for the child. and nutritional needs should be familiar
with these policy statements and guidelines,
In most emergencies, breastfeeding becomes in particular:
even more important for infant nutrition and
health. The resources needed for safe artificial (1) UNHCR’s policy statement
feeding—such as water, fuel and adequate on distribution of milk products
quantities of infant formula—are usually scarce in emergencies (Annex 9a); and

10 According to WHO, infants are defined as those individuals less than 12 months old. Young children are defined as those individuals between 12 and 36 months.
11 A list of criteria for situations in which an alternative to breastfeeding may be considered can be found in the “GIFA/IBFAN/UNICEF/UNHCR/WFP/WHO Infant
and Young Feeding in Emergencies. Operational Guidance for Emergency Relief Staff and Programme Managers. Interagency Working Group on Infant and
Young Child Feeding in Emergencies.” ENN, November 2001.

17
(2) Ten Steps to Successful Breastfeeding b. Breast-feeding and HIV
(WHO/UNICEF) (Annex 9b). For mothers who are HIV-infected,
recommended breastfeeding practices
(3) GIFA/IBFAN/UNICEF/UNHCR/WFP/ can sometimes differ, as HIV can be
WHO Infant and Young Child Feeding in transmitted through breast milk. Globally,
Emergencies. Operational Guidance for the risk of mother-to-child HIV transmission
Emergency Relief Staff and Programme (MTCT) through breastfeeding ranges
Managers. Interagency Working Group between 10 percent and 20 percent if the
on Infant and Young Child Feeding in infant is breast-fed for 18 to 24 months.
Emergencies. ENN, November 2001. On the other hand, infants who are not
Recommendations for practical action breast-fed may be exposed to higher risk
to ensure appropriate infant and young of morbidity and mortality associated with
child feeding in emergencies are outlined malnutrition and infectious diseases
in Annex 9c. other than HIV.

Guiding principles for feeding infants (0-6 months) during emergencies

1. A LL INFANTS , INCLUDING THOSE BORN INTO POPULATIONS AFFECTED BY EMERGENCIES
SHOULD NORMALLY BE EXCLUSIVELY BREAST- FED FOR THE FIRST SIX MONTHS AS
RECOMMENDED BY WHO.
• The beneficial effects of colostrum in breast milk are especially important; infants should be breast-fed
on demand from birth.
• Every effort should be made to identify ways to breast-feed infants whose mothers are absent or incapacitated.
• Re-lactation should be attempted before the use of infant formula is considered.

2. E VERY EFFORT SHOULD BE MADE TO CREATE AND SUSTAIN AN ENVIRONMENT THAT

ENCOURAGES EXCLUSIVE BREASTFEEDING FOR THE FIRST SIX MONTHS , AND CONTINUED
FREQUENT BREASTFEEDING THEREAFTER FOR UP TO TWO YEARS .

3. T HE QUANTITY, DISTRIBUTION AND USE OF BREAST MILK SUBSTITUTE E . G . INFANT FORMULA

AT EMERGENCY SITES SHOULD BE STRICTLY CONTROLLED , USING THE FOLLOWING GU IDELINES :

• Nutritionally adequate infant formula, fed by cup, should be available for infants who do not have access
to breast milk.
• Those responsible for feeding infant formula should be adequately trained and equipped to ensure its safe
preparation and use.
• Feeding infant formula to a minority of children should in no way interfere with protecting and promoting
breastfeeding for the majority.
• The use of infant feeding bottles and artificial teats in emergency settings should be actively discouraged and cup
feeding promoted instead, as cups are much easier to keep clean.

Adapted from Guiding Principles for Feeding Infants and Young Children during Emergencies (WHO, in press).

18
In a typical emergency, the majority It is important to ensure that replacement
of women do not know their HIV status. feeding, advised as one option for feeding
For women to be able to make appropriate infants of HIV-infected women, does not
informed choices on infant feeding, "spill over" to the general population
availability of voluntary counseling as being the best option for all children.
and testing (VCT) is crucial.

Current policies on breastfeeding and infant 2. Complementary feeding for older infants
feeding by HIV-infected women are these and young children12
(WHO, 2001, Inter-agency Taskforce. At 6 months of age, infants should start
Report No. WHO/RHR/01/01.28): to receive complementary foods in addition
to breast milk. These should be safely
1. Exclusive breastfeeding should be prepared from locally available foods that
protected, promoted, and supported are rich in energy and micronutrients
for six months. This applies to women to meet the infants’ changing nutritional
who are known not to be infected with requirements. This can be a significant
HIV and for women whose infection challenge during emergencies, since
status is unknown. constraints often exist. Available foods
may be difficult to prepare into a soft,
2. When replacement feeding is acceptable, semi-solid form. Environmental
feasible, affordable, sustainable and safe, conditions may hinder safe food preparation
avoidance of breastfeeding by HIV-infected and feeding. Traditional ingredients
mothers is recommended; otherwise, that were normally used to prepare weaning
exclusive breastfeeding is recommended foods may not be available. Furthermore,
during the first months of life. basic food-aid commodities—cereals,
pulses and oil—do not by themselves
3. To minimize HIV transmission risk, readily meet the nutritional needs
breastfeeding should be discontinued of young children.
as soon as feasible, taking into account
local circumstances, the individual During the complementary feeding period,
woman's situation and the risks older infants and young children require
of replacement feeding (including foods that are easily digestible. Equally
infections other than HIV and important, complementary foods used during
malnutrition). this period should provide adequate
amounts of fats and oils (30–40 percent
4. HIV-infected women should have access of energy should come from fat). The period
to information, follow-up clinical care from ages 6 to 24 months is the most critical
and support, including family planning for a young child because of rapid growth
services and nutritional support. and an increasing reliance on complementary
food. Therefore, energy derived from

12 ”Older infants” refers to infants between 6 and 12 months of age; “young children” refers
to children between 12 and 36 months.

19
protein should be at least 12 percent. And
these young children must have access to
foods rich in micronutrients for sufficient
growth and development. During the second
6 months of life, breast milk normally
continues to provide about 50 percent
of the nutritional needs of the infant.
Table 6: Options for addressing nutritional needs of older infants and young children
SOURCE OF FOOD
1. Basic food-aid commodities from
general ration with supplements
of inexpensive locally available foods
2. Blended foods (as part of general
ration/ blanket or supplementary)
3. Additional foods in supplementary
feeding programmes
During the second year, it can provide
35-40 percent of total energy needs.
In emergency situations, there are a number
of foods that can be used for the preparation
of suitable complementary foods
(see Table 6 below and Annex 10).
EXAMPLES OF FOODS REMARKS
- Cereals, pulses, oil and sugar - Combinations of cereals and pulses
combined together with a variety with added oil and sugar, suitable
of vegetables and fruit (cereals for complementary foods are described
and pulses must be prepared using in Annex 10.
ground or milled forms)
- Recipes can be developed using
local foods with input from nutrition
and/or health expertise.
- Traditional complementary feeding
practices must be observed and
understood.
- Corn-Soya Blend (CSB), Wheat-Soya - Blended foods processed by roasting
Blend (WSB) or extrusion to improve digestibility.
- Varieties of locally produced blended - Usually additional oil required in
foods such as FAMIX in Ethiopia preparation; DSM can be added
or UNIMIX in Kenya as an additional protein source
and for palatability.
- For growth and development, blended
foods are usually fortified with zinc
and iron and other micronutrients
(see Annex 8).
- Fruit, vegetables, fish, eggs or other -Valuable source of vitamins and minerals
suitable locally available foods
There are a number of other considerations
to take into account when planning food
rations to address the nutritional needs
of older infants and younger children. These
are summarised in Table 7.
20
 Table 7: Challenges and implications for planning food needs
for older infants and young children
IMPLICATIONS FOR PLANNING
ISSUE
FOOD NEEDS
Feeding frequency:
Due to limited stomach capacity, food needs ➪ Provision of sufficient fuel and cooking pots for households
to be provided frequently. with young children.
➪ Supply of food-aid commodities is consistent and timely
to facilitate appropriate food-preparation practices.
➪ Recognition of time required by caregiver for
food-preparation activities.

Household food security:

Household food security may contribute to intra-household* ➪ Adequate and equitable general ration.
food distribution that does not allow nutritional needs
of young children to be met. ➪ Household monitoring as part of general monitoring system.

➪ Community-based surveillance to identify problems

related to intra-household distribution.

Safe and appropriate food preparation

and caring activities:
Lack of access to clean water, poor sanitation, inexperienced
caregivers and mothers overburdened with meeting household
food needs may contribute to abnormal and inadequate
caring practices.
Feeding of orphans (particularly in situations where HIV/AIDS
prevalence is very high)
➪ Health-promotion activities for safe food preparation
and dissemination of information on nutritional needs
of young children.
➪ Access to adequate amounts of clean water
and provision of suitable sanitation facilities.

➪ Additional resources to create a special and appropriate

system to care for those children, preferably in a family
environment.

* Intra-household food distribution refers to how the food available to the household is shared between different family members.

3. Pregnant and lactating women Intra-household food distribution

During pregnancy and lactation, women’s practices in many situations result
nutritional needs for energy, protein and in pregnant and lactating women
micronutrients significantly increase. consuming less than their minimum
Pregnant women require an additional requirements. The consequences of poor
285 kcals/day, and lactating women require nutritional status and inadequate nutritional
an additional 500 kcals/day. Both pregnant intake for women during pregnancy
and lactating women have increased needs and lactation not only directly affects
for micronutrients. Adequate intake of iron, the women’s health status but may have
folate, vitamin A and iodine are particularly a negative impact on infant birth-weight
important for the health of both women and early development. Therefore, to meet
and their infants. The nutritional the additional requirements of pregnancy
requirements of pregnant and lactating and lactation, three important and
women are summarized in Annex 11. complementary interventions

21
—as summarized below in Table 8— may planning figure. However, the increased
be undertaken in addition to the provision micronutrient needs of pregnant and
of a basic food ration. lactating women may not be met through
provision of a basic ration. Various criteria
As mentioned earlier in this document, exist that can be used to determine
the increased energy requirements when a supplementary feeding programme
of pregnant and lactating women are should be implemented—these criteria
incorporated in the 2,100-kcal initial are described in greater detail in the

Table 8: Complementary interventions to meet the additional needs of pregnant

and lactating women
1. FORTIFIED FOOD COMMODITIES*

- Provision of a fortified blended food commodities, designed to provide 10–12 percent (up to 15 percent) of energy
from protein and 20–25 percent energy from fat. The blended food must be fortified to meet two-thirds of daily
requirements for all micronutrients, particularly iron, folic acid and vitamin A.
- The food commodities can be provided through maternal and child health (MCH) structures (in conjunction with
other health services) or through blanket supplementary feeding programmes.

2. MICRONUTRIENT SUPPLEMENT

Pregnant women:
Daily supplements of iron (60 mg/day) and folic acid (400 µg/day)
Lactating women:
Vitamin A: 400 000 IU in 2 doses of 200 000 IU in an interval of at least 24 hours within six weeks after delivery

3. DRINKING WATER

Women are ensured access to sufficient drinking water (extra 1 litre of clean water per day).

4. MALARIA MANAGEMENT IN PREGNANCY

- In areas where malaria is endemic, sulphadoxine-pyrimethamine can be administered through clinics

at the beginning of the second and third trimesters.
- Encourage women to use an impregnated bed net during pregnancy.
- Advise women that they must seek immediate medical attention for episodes of fever.

5. PROPHYLAXIS FOR MANAGEMENT OF INTESTINAL PARASITES

Give each affected woman 500 g mebendazole, in the second and the third trimester.

6. NUTRITION/EDUCATION COUNSELLING FOR WOMEN AND COMMUNITIES

* The food should be provided in addition to the basic general ration, either through the same mechanism as the
general ration distribution or through MCH facilities as a blanket supplementary feeding ration. The food should
be targeted to women in their second and third trimesters of pregnancy and during the first six months of the
lactating period (i.e. for a total period of 12 months).

22
UNHCR/WFP Guidelines for Selective
Feeding Programmes in Emergency Situations
(1999) and The Management of Nutrition
in Major Emergencies (WHO, 2000).
4. Older persons
The energy requirements for older persons
(defined by WHO as those over the age
of 60) usually decrease in comparison with
younger adults as a result of less physical
activity and decreased basal metabolism
that results from a higher relative loss
of muscles mass. The requirements for
micronutrients, however, do not decrease.
Hence, an adequate diet for older persons
must ensure that micronutrient
requirements are still met even with
reduced energy intakes (i.e. foods must be
sufficiently nutrient-dense). Another
important consideration for older persons
is that sufficient intakes of fluids are
required to prevent dehydration and
improve digestion.
Theoretically, a well-planned general
ration is usually adequate for older persons.
However, in practice, a number of other
factors often results in the general ration
not actually meeting the nutritional needs
of the older persons. Some of these factors
include: poor physical access to the ration
as a result of marginalization or isolation;
poor digestibility, especially of whole-grain
cereals; lack of motivation or inability
to prepare foods; and poorer access to
opportunities for supplementing the ration.
In emergency situations, these factors are
exacerbated due to a general breakdown
in normal family and community-support
mechanisms. Table 9 presents a number
of strategies that should be considered
to ensure that the nutritional and food
needs of older persons are better addressed.

Table 9: Considerations to the nutritional and food needs of older persons

1. ACCESS TO EASILY DIGESTIBLE, MICRONUTRIENT-RICH FOODS

- older persons, or families including older persons, should be provided with blended foods. In situations where
blended food is not provided to the whole population, under-5-year-olds, pregnant and lactating women and older
persons should be prioritized.
- Access to milling facilities in situations where whole-grain cereal is provided.
- older persons (caregivers/families) should be assisted and encouraged in small-scale horticultural activities
to increase consumption of fresh foods.

2. FAMILY AND COMMUNITY SUPPORT FOR FOOD PREPARATION

older persons, without family or community support, can be assisted through community-based support programmes.
Assistance with tasks such as collection of rations, food preparation and collection of water may be required
for older persons.

23

C H E C K L I S T:
DOES THE FOOD RATION
ADDRESS THE NUTRITIONAL
NEEDS OF INFANTS,
YOUNG CHILDREN,
PREGNANT/ LACTATING
WOMEN AND OLDER
PERSONS?
✔ Is there an established
understanding of infant feeding
needs and an agreed
strategy/framework to address
these issues?
✔ What actions have been taken
to support and promote breastfeeding
in the population?
✔ What mechanisms are in place
to monitor and control the
distribution of milk powder
and infant formula for those
with specific needs?
✔ Is blended food being made
available in the general ration?
If not, is it being effectively targeted
to families with older infants,
pregnant and lactating women,
and older persons?
✔ Is the strategy for households
to prepare suitable weaning foods
using local foods feasible?
✔ Is there a need to integrate food
(and micronutrient) supplementation
into antenatal services?
✔ Are health promotion and
deworming programmes appropriate
and feasible?
24
F. Use of special commodities:
Milk powder and ready-to-eat-meals
In most situations, certain commodities
such as milk powder and ready-to-eat meals
are not recommended. However, there
are exceptional circumstances where these
commodities can play a useful role
in meeting specific objectives in emergency
situations.
1. Milk Powder
Dried milk powder should NOT be
distributed to emergency-affected populations
as part of the general ration. There is a
danger that it will be used to feed infants.
Also, when it is prepared with unclean water
or in unsanitary conditions, the risk
of high levels of bacterial contamination
is significant.
Milk powder can be used safely:
1. for the preparation of high-energy milk
(HEM) for consumption under strictly
supervised conditions such as well
managed supplementary and therapeutic
feeding programmes;
2. added to a pre-mix with cereal flour,
oil and sugar and targeted to specific
sub-groups of the population (above
6 months of age) to be consumed within
seven days after mixing; or
3. as an ingredient in the local production
of processed foods (e.g. blended foods,
noodles and biscuits).
There are two main types of dried milk
powders: dried skim milk (DSM) and dried
whole milk (DWM). The nutritional value
and reconstitution process of HEM used in
supplementary feeding and therapeutic
feeding is described in UNHCR/WFP’s
“Guidelines for Selective Feeding
in Emergencies” and “Management of Severe
Malnutrition: A Manual for Physicians
and Senior Health Workers” (WHO, 1999)
respectively.
2. Ready-to-eat meals, emergency rations
and high-energy biscuits
In some emergency situations, ready-to-eat
meals may serve a useful temporary purpose,
though their use should be carefully
controlled. Examples of these types of food
include high-energy/protein biscuits,
humanitarian daily rations (HDRs) and
meals ready to eat (MREs). These items
should only be used as an immediate
response at the outset of the emergency
when no other foods/cooking facilities
are available (e.g. when a population
is in transit or fleeing). See Table 10 on
advantages and disadvantages of ready-to-eat
meals and humanitarian daily rations.
Table 10: Advantages and disadvantages of ready-to-eat meals
and humanitarian daily rations
DISADVANTAGES
• Unfamiliar foods for most populations, so culturally
inappropriate and rarely popular
• Packaging difficult to discard appropriately
• Very expensive and supply unsustainable
• High-energy biscuits may not be suitable for use in
therapeutic feeding programmes due to high protein
and high sodium content.
• Biscuits have high market value, so are often sold
and not consumed.
• Water must be taken with high-energy biscuits
(moisture content of biscuits is very low).
25
IV. FACTORS AFFECTING FOOD
PROCESSING, PREPARATION
AND USE
Other important issues that directly influence
the capacity to meet the nutritional needs
of the populations should be given
consideration when setting a food ration
for an emergency situation. Specifically:
A. Local food habits and cultural
acceptability
Every effort should be made to ensure that the
food-aid commodities are culturally acceptable
to the population. The target population
should have the knowledge and the means to
process and prepare the foods using their usual
cooking facilities and fuel whenever possible.
For many populations, food is a component of
cultural identity and plays a significant social
role. The provision of the correct amounts
of energy and nutrients is insufficient if the
ADVANTAGES
• Convenient, fast and logistically easy to distribute
• May be appropriate for populations who are in transit
when cooking facilities not available
• Long shelf life (usually vacuum packed)
• High-energy biscuits suitable for supplementary
feeding on a temporary basis
• High-energy biscuits are fortified with vitamins
and minerals
foods are unacceptable or even unfamiliar
to the population. Emergencies are not
a suitable time to introduce new types of food.
Food preparation should remain with the
family unit. This encourages food preparation
according to local dietary habits and
contributes to important social functions such
as family cohesion.
Institutional-type preparation and provision
of pre-prepared foods should be avoided except
in situations where wet-feeding may be
an appropriate temporary solution (e.g. transit
camps, insecure areas or where the population
is extremely weak and cannot cook
for themselves).
B. Milling requirements
For practical and nutritional reasons,
it is preferable to provide cereal in flour, rather
than grain form, particularly in the early stages
of emergency. Compared to whole grains,
flours have improved palatability and
bio-availability of nutrients, can be effectively
fortified and require less cooking time
(and therefore less fuel). Cereal flours,
though, do have a reduced shelf life
in comparison to whole-grain cereals.
If whole grains are provided, central or local
milling facilities must be available. A number
of factors may limit the effective use of local
mills, such as insufficient capacity and
availability of continuous power supply.
Where whole grain is provided instead of flour,
the ration should include compensation for the
cost and losses of local milling. An additional
10 to 20 percent of cereal staple or equivalent
should be provided in these circumstances.
26
C. Fuel for food preparation
Access to sufficient fuel for food preparation
is a critical issue to consider in emergency
situations. Fuel shortages are often a major
constraint. This can be summarized as
(a) rapid exhaustion of natural resources in
the area due to increased demand; (b) a lack
of access to fuel due to poor security conditions
or risk of mines; (c) foods that require lengthy
cooking (e.g. hard beans); and (d) loss of
access to normal cooking fuel supplies.
The control and management of the natural
resources in the vicinity of the affected
population is important for protecting
the environment and enabling the population
to have sufficient access to fuel resources.
In addition, fuel-saving strategies should be
developed. These strategies may include:
(a) using local technology to modify existing
types of stoves in order to make them more
fuel efficient (e.g. enclosing and insulating
the stoves); (b) adapting food-preparation
techniques that are fuel-efficient (e.g. soaking
beans prior to cooking, using pots with lids
and putting fires out after cooking is
complete). To be effective, fuel-saving
strategies require community involvement
in their development and implementation.
D. Non-food items required for food
preparation
The availability of adequate supplies
of essential non-food items such as water and
cooking containers (pots) must be ensured.
Iron pots, in particular, may be selected
as a way of providing dietary iron.
V. MANAGEMENT OF
FOOD-RELATED ISSUES
A. Temporary substitution of food items
Unavailable food commodities can be
replaced by another food in order to maintain
the energy and/or protein level of the food
basket. These substitutions should only be
considered as a temporary measure and should
not be implemented for longer than one
month. While the substitutions maintain
energy/protein levels, they do not maintain
equal levels of other nutrients.
The temporary substitution ratios for common
food items are shown in the box below:
Blended food for beans
Sugar for oil
Cereal for beans
Cereal for oil (but not oil for cereal)
Inappropriate substitutions—such as
the provision of unfamiliar foods, the use
of unsolicited donations of expired foods
or the use of highly processed commercial
foods13—should be avoided. In all situations
where temporary substitutions are necessary,
efforts should be made to inform
the population of the temporary
substitution arrangement and
its expected duration.
13 Some examples of inappropriate foods include sweetened processed foods for young children and pre-prepared emergency rations
such as Humanitarian Daily Rations (HDRs), which often contain unfamiliar foods.
Practical example:
The daily rations for cereals and beans are
420 g and 50 g respectively. Beans become
temporarily unavailable and an appropriate
substitution is required. Efforts are made
to secure an alternative high-protein food.
Although dried fish can be procured
regionally, only a small minority of the
population eats fish. Groundnuts are familiar
to the population, but cannot be procured
locally in sufficient quantities. Therefore,
a cereal substitution is adopted, and an
additional 100 g per day of cereal is provided.
A new total of 520 g of cereal is provided
daily in the ration for one month while
arrangements are made to procure sufficient
quantities of beans or groundnuts.
1:1
Note: Where maize is the staple cereal,
2:1
the additional cereal should be fortified blended
2:1 food. Maize has limited bioavailable niacin,
3:1 so overdependence creates the risk of pellagra.
27
B. Packaging of food-aid commodities
Proper food packaging is necessary to preserve
and protect the quality of commodities.
Proper labelling of food-aid commodities
provides vital information to field staff.
Packaging should be environmentally friendly
and, if possible, serve as an additional
resource to the population as shown
in the box below.
FOOD-PACKAGING CONSIDERATIONS:
• Protection potential
• Labelling on packaging
• Disposal and environmental considerations
• Practical uses of packaging for population
28
C. Exchange and trade of rations
The practice of exchange, bartering or re-sale
of food-aid commodities in emergency
situations may facilitate diversification
of food and enable access to a number of foods
that are not provided in the ration
(e.g. fresh fruit, vegetables, meat, fish or eggs).
The sale of food in the marketplace does
not necessarily indicate a food surplus.
The rationale for trading food may simply
be to diversify the diet and to improve
its palatability and quality.
Even when there is no evidence of a large-
scale diversion of food, the situation should
be carefully monitored to determine the
reasons why food is being sold or exchanged.
Monitoring mechanisms should be
• Strength/water-resistant capacity
• Appropriate packaging can help retain micronutrients
in the food commodity (e.g. iodine in salt, vitamins
and minerals in blended foods).
• The right packaging units facilitate easy distribution
(kg/package).
• Foods should be clearly labelled with production date,
nutritive value and composition and date of expiry.
• Where applicable, instructions for food preparation
should be given in a language that is understood by
the population.
• Discarding packaging should be easy and safe, with
resources required for disposal provided if necessary.
• Potential for package to be used by population (e.g.
cereal sacks woven into mats, oil containers used as
water containers, etc.)
• Mechanism in place to distribute useful food
packaging
established to ensure that the practice of food
trade is not having an overall negative effect
on food access at the household level.
D. Quality control
A system of quality control for all commodities
must be implemented to ensure that food
distributed to refugees is of good quality and
safe for human consumption. The acceptability
and consumption of food is directly influenced
by the quality of the food.
The following quality-control measures
are required during storage, transport
and distribution:
• Suppliers of food commodities must be
carefully scrutinized to ensure that a regular
quality-control check is done. Provided
commodities must meet standards (official
government or Codex Alimentarius
standards) with respect to packaging,
labelling, shelf-life, etc.
• All food received should have a minimum
shelf life of six months (except for fresh
foods and maize meal) and be distributed
well before date of expiry.
• Adequate storage structures should be
in place; storage facilities should be
well-managed and should conduct regular
checks on the quality of food items.
• Staff should be versed in potential health
hazards caused by improper handling,
storage and distribution of food.
• Written procedures should be in place
for checking the quality of food
at the distribution stage.
29
• Fumigation and food quality control
measures should be in place.
• Discarding of spoiled food commodities
should be documented and carried out safely,
according to local health regulations.
Complaints received from the population
on the poor quality of food (or, in some
extreme cases, outbreaks of food-borne
diseases) may indicate that the foods being
provided are of inadequate quality. A failure
to provide good-quality foods will be
a major constraint towards meeting
the nutritional needs of the population.
C H E C K L I S T:
HAVE CULTURAL HABITS
AND FOOD MANAGEMENT
BEEN CONSIDERED?
✔ Are the foods familiar to the
population and generally regarded as
“good” foods?
✔ If the cereal is received in
whole-grain form, are there adequate
milling facilities? Have losses for
milling costs being compensated for?
✔ Do all households have access to fuel
and cooking facilities?
✔ Is a fuel-saving strategy in place?
✔ Are packaging materials being
appropriately discarded or distributed
for re-use?
✔ Are food commodities being
exchanged? For what? Is it likely to
affect food access?
MONITORING AND FOLLOW-UP
Estimating the food requirements
of a population and planning a ration are
inadequate strategies on their own to ensure
that the needs are being met in an emergency
situation. First of all, a monitoring system
must be established to ensure that any
inadequacies in the ration are discovered
in a timely manner. Secondly, a strategy
outlining actions to be taken in response
to food shortages or inadequate rations should
be in place. Thirdly, given that access to food
can change dramatically over time, and
the opportunities for obtaining food through
the population’s own means differ
significantly between situations, it is essential
to make strong links between food aid and
the potential for food production from
the outset of the emergency.
I. MONITORING MECHANISMS
TO ASSESS THE ADEQUACY
OF THE RATION
The monitoring of a general food-distribution
programme is generally implemented on four
different levels:
1) Food pipeline and supply - at resourcing
level, pledges, shipments, delivery to the
camps, available stock at the warehouse.
This is achieved through reports and
record checks (e.g. waybills, logbooks,
etc.).
2) Food-distribution process - Monitor
the actual organization of the distribution
system: frequency, location of distribution
sites, availability of registration and
30
ration cards, food-basket monitoring.
3) Community level - Monitor food use,
sale and exchange, and their impact
on prevalence of protein-energy
malnutrition and micronutrient
deficiencies. Also link with health
monitoring system to assess all causes
of malnutrition.
4) Household level - to determine
individuals’ access, preparation
and consumption of food; infant feeding
practices; and women’s perception of the
quality and value of the food
commodities
Monitoring at the community and
household level is particularly crucial in
determining the adequacy of the general
ration and its nutritional impact.
II. MONITORING TOOLS
Providing details on the methods for these
monitoring tools is beyond the scope of these
guidelines. There is no single monitoring tool
that can meet all information requirements
in all circumstances. Some examples
of monitoring tools that are most often used
are described in Table 11. The selection
of specific tools to use in a given situation
will be determined by the objectives of the
emergency intervention, the resources
available and local conditions.
Information gathered through monitoring
should be used on an ongoing basis to review
Table 11: Tools and types of information required
for monitoring adequacy of ration

METHODOLOGY PURPOSE AND TYPE OF INFORMATION COLLECTED

Food Basket Monitoring • To determine the actual quantity of the ration that is received by the population in relation
(FBM) to the intended or theoretical amounts pledged or programmed.
• At a short distance from the distribution site and/or at the household level, a systematic sample
of households is selected. Each of their food items is weighed to determine the amount of food received
per person per day.
Reference: Nutrition Guidelines. Medecins Sans Frontieres. 1995. UNHCR Commodity Distribution:
A Practical Guide for Field staff. UNHCR. 1997.

Qualitative • To provide an understanding of the population’s beliefs, opinions and perceptions and give information
methodologies on the reasons, causes and relative differences of quantitative findings.
(rapid assessments)
• Some examples of methods include focus group discussions, direct observation, transect walks
and semi-structured interviews.
Reference: WFP. Food and Nutrition Handbook. 2000.

Household surveys • To assess demographic information, mortality data, morbidity, food stocks and food use.
(quantitative)
• Household questionnaires are collected from a representative sample of households. Results are
analyzed statistically at a central level.
• Assessment of use of infant formula, caring capacity and infant and young
child feeding practices.

Anthropometric • To assess and estimate prevalence of malnutrition, including micronutrient deficiencies, and to identify
and micronutrient- underlying causes and risk factors of malnutrition.
deficiency disease
• Collection of anthropometric data on children (and other groups) using a random representative sample
surveys
to determine prevalence of acute malnutrition.
• Assessment of (i) visible clinical signs of micronutrient deficiencies (e.g. goitre); and (ii) sub-clinical
deficiencies through biochemical assessment (e.g. serum retinol, hemoglobin or urinary iodine).
Reference: The Management of Nutrition in Major Emergencies. WHO, UNHCR, IFRC, WFP. Geneva,
World Health Organisation. 2000.

Household Food • To quantify household capacity to access and produce food and to estimate household food shortages
Economy Assessments between different socio-economic groups.
• Population divided up into discrete groups on the basis of wealth to determine differences in access
for each group. Information collected is specific, quantified information concerning the food sources,
income and expenditures of what would be a “typical” household for each group.
(Note: This method is based on purposive sampling and grounded in nutritional principles; requires
sound understanding of context and involves rigorous cross-checking processes.)
Reference: The Household Economy Approach: A Resource Manual for Practitioners, Save the Children (UK). 2000.

Food and Livelihood • To analyze and understand basic causes and processes of food and livelihood security at national,
Security Assessment regional and community levels and to identify areas of relative food insecurity.

• Based on combination of quantitative and qualitative approaches. Focuses on the context (social,
political, economic and environmental); peoples’ resources (material and natural resources and skills);
access to food and livelihood strategies (food production, employment); institutional processes and
structures (informal and formal).
Reference: UNICEF, Conceptual Framework, Annex 12.

31
and further refine nutritional needs estimates III. FOLLOW-UP TO MONITORING
of affected populations. These revisions
are particularly important where a specific In emergency situations, a number
event may negatively affect food access of constraints may exist that limit
or in stable situations where the population’s the potential for delivering a ration that
own means of production is gradually is adequate in quantity and quality.
improving. Examples of strategies to address It is paramount, therefore, that appropriate
some of the problems identified by corrective measures are implemented
monitoring are listed in Table 12. in the event of a shortfall in order
to prevent any negative consequences
among the target population. In all
circumstances, the population should be
informed of expected or actual shortfalls.

Table 12: Examples of strategies to address problems

documented by monitoring

PROBLEM POTENTIAL RESPONSE AND ACTION

Food inadequacy • Investigate and document the population’s capacity to cope with the food deficit
(low in overall and the implications thereof.
energy) • Advocate for additional food to meet requirements.
• Attempt to get an accurate estimate of population numbers.
• Establish contingency plan (e.g. blanket feeding to meet needs of the most vulnerable,
including the elderly, the chronically ill, under-5-year-olds).
• Reduce ration amount for whole population while maintaining a safety net programme
of full distribution to separate subgroups such as identified vulnerable members.

Inequitable • Identify which groups are receiving lesser rations and the possible reasons.
distribution (through • Identify with community, authorities and food-distribution team how to resolve problem.
results of FBM)
• Monitor vulnerable groups carefully and continue FBM.

Missing commodities • Implement a substitution strategy, noting risks involved (e.g. loss of micronutrients).
• Ensure distribution of normal ration is resumed after one month.

Missing • Provide fortified blended food.

micronutrients • Identify specific micronutrient(s) that are likely to be in deficit, then identify the
appropriate food(s) that can be fortified, or the foods that are a rich source of these
micronutrient(s). Iron pots should be considered as a way of providing dietary iron.

Transport difficulties • Prioritize foods that provide the bulk of the ration (e.g. cereals and pulses)
as a short-term strategy.
• Investigate feasibility of alternative mechanism of transport for delivery.

Source: Jaspars, S. and Young, H. General Food Distribution in Emergencies:

From Nutritional Needs to Political Priorities.
RRN Good Practice Review #3, Dec 1995

32
IV. ACCESS TO OTHER SOURCES
OF FOOD IN POST-EMERGENCY
PHASE
A. Assessing food and nutritional needs
in post-emergencies
The provision of assistance to emergency-
affected populations on the basis of need
is a well-established principle. It is during
the initial phase of the emergency that
populations are most likely to be entirely
reliant on food aid. However, with time,
many affected populations may become
less dependent. Consequently, the objectives
of food assistance may change. In protracted
situations, food assistance will usually
aim to support livelihoods. Food assistance
in these contexts will therefore aim
to complement the food that the population
is able to obtain for themselves. Estimating
food and nutritional needs in post-emergency
phase is thus more complex, since it
requires an analysis of the extent
to which populations are able to meet their
food needs through their own means.

Table 13: Principles for estimating food and nutritional needs

in post-emergencies
1. ADOPTION OF A HOLISTIC “FOOD SECURITY” APPROACH THAT EXAMINES
HOW ALL GROUPS WITHIN A POPULATION ACTUALLY ACCESS FOOD.

This requires taking into account basic needs other than food (and the possible trade-off between food and other
basic needs), different types of livelihood systems and the effects and desirability of the various coping mechanisms
adopted by the affected population.

2. THE UNDERLYING CAUSES, APART FROM FOOD AVAILABILITY, THAT

INFLUENCE FOOD CONSUMPTION AND NUTRITIONAL STATUS HAVE
TO BE UNDERSTOOD.

This requires taking into account health determinants, including access to health services; and caring capacity
and social behaviours, including capacity for breastfeeding and adequate complementary feeding practices for
infants and young children.

3. UNDERSTANDING OF THE SOCIAL AND POLITICAL CONTEXT

OF THE AFFECTED POPULATION.

This is essential for identifying the reasons for certain groups being particularly food insecure.

4. ONGOING MONITORING OF THE FOOD-SECURITY SITUATION, NUTRITIONAL

STATUS AND THE FACTORS THAT INFLUENCE ACCESS TO FOOD.

The need is for surveillance with occasional ad hoc assessments.

5. ADOPTING PARTICIPATORY APPROACHES AND MAINTAINING ONGOING

DIALOGUE BETWEEN AGENCIES AND THE AFFECTED POPULATION.

Allows for more in-depth understanding of the reasons for food insecurity.

Source: Food Security Assessments, Self-reliance, Targeting

and Phasing out in Ongoing refugee situations. Summary
Report of an Inter-Agency Workshop, WFP, UNHCR and ENN,
Nov 1999.

33
B. Supporting recovery V. SELF-RELIANCE AND EXIT
During the initial stage of the emergency, STRATEGIES14
in collaboration with the host-country
government, a strategy should be
Self-reliance relates not only to food
developed to support and strengthen
(in)security but also to other basic needs.
the affected population’s opportunities
People are self-reliant when they can cover
to access food through their own means
all their basic needs without external
in the medium and longer-term. Strategies
support. An accurate understanding
to improve the availability, access
of levels of self-reliance—and of coping
and utilization of food resources should be
strategies more generally—of different
formulated at the same time as food
sub-groups within the population
distributions begin in order to support
is necessary to design and adjust assistance
recovery of food-production capability
interventions.
and recovery of health status, and to
encourage income-generating activities.
Supporting self-reliance is important
to enhance the capacities and self-esteem
Food and nutritional needs during
of the affected population and may contribute
the post-emergency phase (Table 13)
to reducing dependence on food aid. It can
will be linked to (i) the extent to which
also facilitate the eventual reintegration,
the affected population can engage in the
or resettlement, of populations.
local economy, and (ii) the effectiveness
In some emergency situations, especially
of activities implemented to support
closed camps, opportunities for self-reliance
livelihood strategies. Such activities
may be limited. In all situations, a number
may include: rehabilitation of local trade
of factors and considerations should be taken
and markets; distribution of appropriate
into account when examining the potential
seed varieties and agricultural tools;
of self-reliance activities. Specifically:
distribution of fishing equipment;
income-generating activities; and
• Impact of existing and potential
distribution of non-food items.
self-reliance activities on the local
population, the environment, gender
roles and responsibilities, and caring
practices, including infant- and young
child–feeding practices;

• Long-term sustainability of self-reliance

activities and of the expected
production/income; and

14 Adapted from: Food Security Assessments, Self-reliance, Targeting and Phasing Out in Ongoing refugee situations.
Summary Report of an Inter-Agency Workshop, WFP, UNHCR and ENN, Nov 1999.

34
• Discouragement of activities that may be
C H E C K L I S T:
illegal or socially undesirable or that are
HAVE LONGER-TERM
regarded as “survival” activities and carry
PLANNING AND
negative consequences (e.g. prostitution).
MONITORING MECHANISMS
The interpretation of any improvement BEEN TAKEN INTO
in nutritional data (e.g. decrease CONSIDERATION?
in prevalence of acute malnutrition)
should always be interpreted in the context ✔ What monitoring activities have
of food-security information. An been established to assess the
improvement in nutritional status adequacy of the ration?
may indicate an effective food and/or ✔ In the case of an inadequate ration,
health intervention. However, it does what action has been taken to
not necessarily mean that the population correct the inadequacy?
has access to food from their own
production. ✔ Is the food-aid programme addressing
recovery of the population?
This needs to be demonstrated independently ✔ Is there a strategy in place to support
from investigations into the population’s self-reliance activities?
capacity to access food through their own
✔ What contingency plan is in place to
means. A careful analysis of the findings
address any deterioration?
will then assist in determining the extent
to which external food assistance ✔ Does information being collected on
is still required. an ongoing basis verify that food aid
adequately complements food
obtained by the population?

35
FURTHER READING

The following is a list of practical reference material on estimating food and nutritional needs.

1. Ad Hoc Group on Infant Feeding in Emergencies. Infant Feeding in Emergencies Policy,

Strategy and Practice. Emergency Nutrition Network. 1999. Dublin.

2. Cameron, M. & Hofvander Y. Manual on Feeding Infants and Young Children. Third Edition.
Oxford University Press Publications. 1989. New York.

3. FAO. The Right to Food; in theory and practice. FAO. 1998. Rome.

4. FAO/WHO Joint Expert Consultation. Energy and Protein Requirements.

Technical Report Series 724. WHO. 1985. Geneva.

5. Howson, CP., Kennedy, E.T. & Horwitz, A. Prevention of Micronutrient Deficiencies: Tools for
Policy Makers and Public Health Workers. National Academy Press. 1988. Washington, DC.

6. Jaspars, S. & Young, H. General Food Distribution in Emergencies: from Nutritional Needs
to Political Priorities. Good Practice Review 3. 1996. Relief and Rehabilitation Network,
Overseas Development Institute. 1996. London.

7. MSF-Holland. Food Security Assessments in Emergencies. Report of an Inter-Agency Workshop.

December 1997.

8. Sphere Project. Minimum Standards in Nutrition in Nutrition and Food Aid (Chapters 3 and 4).
Humanitarian Charter and Minimum Standards in Disaster Response. 1998. Geneva.

9. UNHCR. Handbook for Emergencies. Second Edition. UNHCR. 1999.

10. UNHCR/UNICEF. Memorandum of Understanding. March 1996.

11. UNHCR/WFP. Memorandum of Understanding on the Joint Working Arrangements

for Refugee, Returnee and Internally Displaced Persons. July 2002.

12. UNHCR/WFP/ENN. Food Security Assessments, Self-Reliance, Targeting and Phasing-out

in Ongoing Refugee Situations. Summary of an Inter-Agency Workshop. January 2000. Rome.

13. UNHCR/WHO. Scurvy and its prevention and control in major emergencies. WHO/NHD/99.11

14. UNHCR/WHO. Thiamine deficiency and its prevention and control in major emergencies.
WHO/NHD/99.13.

15. UNHCR/WHO. Pellagra and its prevention and control in major emergencies. WHO/NHD/00.10.

36
16. WHO. Iron Deficiency Anaemia. Assessment, Prevention, and Control.
A guide for programme managers. UNICEF/UNU/WHO. WHO/NHD/01.3.

17. WHO. Assessment of Iodine Deficiency Disorders and Monitoring their Elimination.
A Guide for Programme Managers. Second Edition. ICCIDD/UNICEF/WHO. WHO/NHD/01.1

18. WHO. Indicators for Assessing Vitamin A Deficiency and their Application in Monitoring
and Evaluating Intervention Programmes. WHO/NUT/96.10

19. WHO. Complementary Feeding. Family foods for breast-fed children. WHO/NHD/00.1

20. WHO. Infant Feeding in Emergencies; A guide for mothers. WHO Regional Office
for Europe. 1997. Copenhagen.

21. WHO. The Management of Nutrition in Major Emergencies. 2000. Geneva.

22. WHO/UNICEF/IVACG Task Force. Vitamin A Supplements-A Guide to their Use in the Treatment
and Prevention of Vitamin A Deficiency and Xerophthalmia. Second Edition. 1997. Geneva.

23. WFP. Emergency Needs Assessment Guidelines. WFP. 1999. Rome.

24. WFP. Participatory Techniques and Tools - A WFP Guide. WFP. 2000. Rome.

25. WFP. Food and Nutrition Handbook. WFP. 2000. Rome.

26. WFP. Emergency Pocket Book. WFP. 2002. Rome.

27. WFP/UNESCO/WHO. School Feeding Handbook. 1999. Rome.

28. WFP/UNICEF. Memorandum of Understanding in Emergency and Rehabilitation Interventions.

February 1998.

29. Young, H. & Jaspars, S. Nutrition Matters; People, Food and Famine. Intermediate Technology
Publications. 1995.

30. Young H., Jaspars S., Brown R., Frize J. & Khogali H. Food Security and Assessments
in Emergencies: A Livelihoods Approach. Humanitarian Practice Network,
Overseas Development Institute. 2001. London.

37
ANNEXES

ANNEX 1:
Energy requirements for emergency-affected populations
Developing country profile (demography and anthropometry); Kilocalories per day
Age/sex Malea Femalea Male & Femalea
group (years)

% of Energy % of Energy % of Energy

total requirement total requirement total requirement
population per caput population per caput population per caput
0 1.31 850 1.27 780 2.59 820
1b 1.26 1,250 1.20 1,190 2.46 1,220
2 b
1.25 1,430 1.20 1,330 2.45 1,380
3b 1.25 1,560 1.19 1,440 2.44 1,500
4b 1.24 1,690 1.18 1,540 2.43 1,620
0–4 6.32 1,320 6.05 1250 12.37 1,290
5–9 6.00 1,980 5.69 1730 11.69 1,860
10–14 5.39 2,370 5.13 2040 10.53 2,210
15–19 4.89 2,700 4.64 2120 9.54 2,420
20–59c 24.80 2,460 23.82 1990 48.63 2,230
60+c 3.42 2,010 3.82 1780 7.24 1,890
Pregnant 2.4 285 (extra) 2.4 285 (extra)
Lactating 2.6 500 (extra) 2.6 500 (extra)
Whole
50.84 2,250 49.16 1910 2,080
Population

Source: WHO. The management of nutrition in major emergencies. Geneva, 2000.

a: Adult weight: male 60 kg, female 52 kg.
b: Population estimates for years 1, 2, 3 and 4 are not available from UN. Estimates for these years were made by interpolation between the figures given
by UN for 0 year and 5 years.
c: The figures given here apply for “light” activity level (1.55 x BMR for men, 1.56 x BMR for women). (The BMR [basal metabolic rate] is the rate of energy
expenditure of the body when at complete rest [e.g. sleeping]. It is estimated at 1,355 kcal/person/day.)

38
 ANNEX 2: Vitamin and Mineral requirements—Safe levels of intake (summary)a
Age/Sex Group Vitamin A (mg retinol Vitamin D Thiamine Riboflavin Niacin equivalents Folic acid Vitamin B12 Vitamin C Iron (mg):d Iodine
(years) equivalents REb) (µg calciferol) (mg)c (mg)c (mg)c (µg) (µg) (mg) Low (5-9%) (µg)

0 350 10.0 0.3 0.5 4.2 24 0.1 20 13 50-90e

1 400 10.0 0.5 0.8 6.4 50 0.45 20 8 90
2 400 10.0 0.55 0.9 7.5 50 0.53 20 8 90
3 400 10.0 0.60 1.0 8.2 50 0.61 20 9 90
4 400 10.0 0.65 1.1 8.9 50 0.69 20 9 90
0-4 390 10.0 0.5 0.8 7.1 45 0.50 20 9 90
5-9 400 2.5 0.75 1.2 10.3 80 0.82 20 16 110

10-14 M 550 2.5 0.95 1.6 13.1 150 1.0 25 24 140

10-14 F 550 2.5 0.8 1.35 11.3 130 1.0 25 27 140
10-14 M & F 550 2.5 0.9 1.5 12.2 140 1.0 25 26 140

39
15-19 M 600 2.5 1.1 1.8 15.3 200 1.0 30 15 150
15-19 F 500 2.5 0.9 1.4 11.9 170 1.0 30 32 150
15-19 M & F 550 2.5 1.0 1.6 13.6 185 1.0 30 24 150

20-59 M 600 2.5 1.0 1.7 14.5 200 1.0 30 15 150

20-59 F 500 2.5 0.8 1.4 11.5 170 1.0 30 32 150
20-59 M & F 570 2.5 0.9 1.55 12.9 185 1.0 30 23 150
Pregnant +100 + 7.5 + 0.1 +0.1 +1.1 + 250 + 0.4 + 20 + 60-120 + 50
Lactating +350 + 7.5 + 0.2 +0.3 +2.7 + 100 + 0.3 + 20 17 + 50

60+ M 600 3.2 0.9 1.4 11.9 200 1.0 30 15 150

60+ F 500 3.2 0.75 1.2 10.3 170 1.0 30 15 150
60+ M & F 540 3.2 0.8 1.3 10.9 185 1.0 30 15 150
Whole Population 500 3.2 - 3.8f 0.9 1.4 12.0 160 0.9 28 22 150
a: Adapted form The management of nutrition in major emergencies. WHO, 2000.
b: Vitamin A requirements may be met by absorption of vitamin A itself (retinol) or provitamin A carotenoids, which have varying equivalence in terms of vitamin A activity. The requirement is expressed in terms of the retinol equivalent (RE), which is defined by the following relationships:
1µg retinol = 1.0mg RE; 1mg beta-carotene = 0.167:g RE; 1µg other provitamin A carotenoids = 0.084mg RE
c: B-vitamin requirements are proportional to energy intake and are calculated: Thiamine: 0.4 mg per 1,000 kilocalories ingested; riboflavin: 0.6 mg per 1,000 kilocalories ingested; niacin equivalents: 6.6 mg per 1,000 kilocalories.
d: Basis of calculation of iron requirements= 7.5% (diet as in developing countries)
e: The lower figure is for breast-fed infants, the higher for infants fed on breast-milk substitutes.
f: The higher figure is used for developing countries because of the larger proportion of children under 5 years whose requirement is greater.
ANNEX 3:
Nutritional value of commonly used food-aid commodities
Nutritional value/100 g
Energy Protein Fat
(kcal) (g) (g)
Cereals
Wheat 330 12.3 1.5
Rice 360 7.0 0.5
Sorghum/millet 335 11.0 3.0
Maize 350 10.0 4.0

Processed Cereals
Maize meal 360 9.0 3.5
Wheat flour 350 11.5 1.5
Bulgur wheat 350 11.0 1.5

Blended Foods
Corn-soya blend (CSB) 380 18.0 6.0
Corn-soya milk (CSM) 380 20.0 6.0
Wheat-soya blend (WSB) 370 20.0 6.0
Soya-fortified bulgur wheat 350 17.0 1.5
Soya-fortified maize meal 390 13.0 1.5
Soya-fortified wheat flour 360 16.0 1.3
Soya-fortified sorghum grits 360 16.0 1.0

Dairy Products
Dried skim milk (enriched) (DSM) 360 36.0 1.0
Dried skim milk (plain) (DSM) 360 36.0 1.0
Dried whole milk (DWM) 500 25.0 27.0
Canned cheese 355 22.5 28.0
Therapeutic milk (TM) 540 14.7 31.5

Meat & Fish

Canned meat 220 21.0 15.0
Dried salted fish 270 47.0 7.5
Canned fish 305 22.0 24.0

Oil & Fats

Vegetable oil 885 - 100.0
Butter oil 860 - 98.0
Edible fat 900 - 100.0

Pulses
Beans 335 20.0 1.2
Peas 335 22.0 1.4
Lentils 340 20.0 0.6

Miscellaneous
Sugar 400 - -
Dried fruit 270 4.0 0.5
Dates 245 2.0 0.5
Tea (black) - - -
Iodized salt - - -
Source: WFP. Food and Nutrition Handbook. 2000.

40
ANNEX 4:
Micronutrient Content of Selected Food-Aid Commodities
Micronutrients per 100 g edible portion
Calcium Iron Vitamin A Thiamine Riboflavin Niacin Folate Vitamin C
(mg) (mg) (µg) B1 (mg) B2 (mg) B3 (mg) (µg) (mg)
Cereals
Wheat 36 4.0 0 0.3 0.07 5.0 51 0
Rice (parboiled) 7 1.2 0 0.2 0.08 2.6 11 0
Sorghum 26 4.5 0 0.34 0.15 3.3 U 0
Maize whole yellow 13 4.9 0 0.32 0.12 1.7 U 0
Wheat flour 15 1.5 0 0.10 0.03 0.7 22 0

Processed Cereals
Maize flour 10 2.5 0 0.3 0.10 1.8 U 0
Wheat flour* 29 3.7 0 0.28 0.14 4.5 U 0
Bulgur wheat 23 7.8 0 0.30 0.10 5.5 38 0

Blended Foods
Corn-soya blend (CSB) 513 18.5 500 0.65 0.5 6.8 U 40
Wheat-soya blend (WSB) 750 20.8 498 1.50 0.6 9.1 U 40
Soya-fortified bulgur wheat 54 4.7 0 0.25 0.13 4.2 74 0
Soya-fortified maize meal 178 4.8 228 0.70 0.3 3.1 U 0
Soya-fortified wheat flour 211 4.8 265 0.66 0.36 4.6 U 0
Soya-fortified sorghum grits 40 2.0 - 0.2 0.10 1.7 50 0

Dairy Products
Dried skim milk (DSM) 1257 1.0 1,500 0.42 1.55 1.0 50 0
Dried whole milk (DWM) 912 0.5 280 0.28 1.21 0.6 37 0
Canned cheese 630 0.2 120 0.03 0.45 0.2 U 0

Meat & Fish

Canned meat 14 4.1 0 0.20 0.23 3.2 2 0
Dried salted fish 343 2.8 0 0.07 0.11 8.6 U 0
Canned fish 330 2.7 0 0.40 0.30 6.5 16 0

Oil & Fats

Vegetable oil 0 0 0 0 0 0 0 0
Butter oil 0 0 0 0 0 0 0 0

Pulses
Bean (kidney-dry) 143 8.2 0 0.5 0.22 2.1 180 0
Peas 130 5.2 0 0.6 0.19 3.0 100 0
Lentils 51 9.0 0 0.5 0.25 2.6 U 0

Miscellaneous
Sugar 0 0 0 0 0 0 0 0
Dates 32 1.2 0 0.09 0.10 2.2 13 0
U: unknown
*: medium extraction
Adapted from Food and Nutrition in the Management of Group Feeding (Revision 1) FAO, Rome 1993 (Annex 1, p. 149-54)

41
ANNEX 5:
Example of How to Calculate the Percentage Energy of Protein and Fat in a Ration

Refer to the table in Annex 3 showing nutritional value of commonly used food-aid commodities.
Using the following ration as an example:

Food item Quantity in g per day per person

Wheat flour 420
Pulses 50
Oil 25
Canned fish 20
Blended food 40
Salt 5

As shown in the table below:

Step 1 ➪ Determine the energy, fat and protein content for 100 g of food from the table.
Step 2 ➪ Calculate the amounts for the quantities given in the ration.
Step 3 ➪ Sum the total amounts for each for the ration.

For 100 g of food item (step 1) For quantity of food item in ration (step 2)
Commodity
(quantity) Energy Protein Fat Energy Protein Fat
(kcal) (g) (g) (kcal) (g) (g)
Maize flour (420 g) 360 9.0 3.5 1,512 37.8 14.7
Pulses/beans (50 g) 335 20.0 1.2 168 10 0.6
Oil (25 g) 885 - 100 221 - 25
Canned fish (20 g) 305 22.0 24.0 61 4.4 4.8
Blended food (40 g) 380 18.0 6.0 152 7.2 2.4
Salt (5 g) - - - - - -

Total (step 3) 2,114 59.4 47.5

To calculate percentage energy from protein and fat:

For calculation of percentage energy from fat and protein:

➪ 1 g of protein provides 4 kcal of energy
➪ 1 g of fat provides 9 kcal of energy

Step 4 ➪ Calculate percentage energy from protein

(Total g of protein) x (4 kcal): 59.4 x 4 = 237.6
(Total energy from protein)/(Total energy in ration) x 100%: 237.6/2114 x 100%
= 11.2%

Step 5 ➪ Calculate percentage energy from fat

(Total g of fat) x (9 kcal): 47.5 x 9 = 427.5
(Total energy from fat)/(Total energy in ration) x 100%: 427.5/2114 x 100%
= 20.0%

42
ANNEX 6:
Example of How to Calculate the Micronutrient Content of a Ration

Refer to the table in Annex 4 showing micronutrient content of commonly used food-aid commodities.
Using the following ration as an example:

Food item Quantity in g per day per person

Maize flour 400
Pulses 60
Oil 25
Blended food 50
Sugar 15
Salt 5

As shown in the table below:

Step 1 ➪ Determine the micronutrient content for 100 g of food using the information from the table.
Step 2 ➪ Calculate the amounts of the micronutrients provided by the amount of ration provided.
Step 3 ➪ Sum the total amounts for each micronutrient in the ration.

For example, the above ration contains the following amounts of micronutrients:

Iron Vitamin A Vitamin Vitamin Vitamin Folate Vitamin C Iodine

(mg) (µg) B1 B2 B3 (µg) (mg) (µg)
Thiamine Riboflavin Niacin
(mg) (mg) (mg)

Quantities in ration (above) 25.3 500 2.3 0.8 13.0 108.0 20 150

Step 4 ➪ Calculate the percentage of micronutrients provided by the ration in comparison

to the requirements.

Iron Vitamin A Vitamin Vitamin Vitamin Folate Vitamin C Iodine

(mg) (µg) B1 B2 B3 (µg) (mg) (µg)
Thiamine Riboflavin Niacin
(mg) (mg) (mg)

Amounts in ration 25.3 500 2.3 0.8 13.0 108.0 20 150

Recommended daily intakes* 22.0 500 0.9 1.4 12.0 160 28.0 150

Percentage of requirements 115% 100% 250% 57%* 108% 67%* 71%* 100%

* mean per capita requirements

Step 5 ➪ Identify which vitamins are deficient and choose appropriate strategies and action
to correct this.

The amounts of Vitamin B2 (Riboflavin), Folate and Vitamin C (Vitamin C) are lower than the required amounts for
the whole population.

Note: The figures do not take into account the actual micronutrient status of the population concerned and therefore the actual
micronutrient needs of the population concerned (there might be population groups that have higher needs).

43
ANNEX 7:
Blended foods: Requirements and specifications

Blended foods are a mixture of milled cereals and other ingredients such as pulses, dried skimmed milk and possibly
sugar and oil. Blended foods are produced by:
• Dry blending of milled ingredients
• Toasting or roasting and milling of ingredients
• Extrusion cooking, which results in a “pre-cooked” food
• The final product is milled into a fine powder and fortified with mineral and vitamin premix.

A range of blended foods is available, such as:

• Corn-Soya Blend (produced in the USA)
• Locally produced blended foods, e.g. Likuni Phala (Malawi), UNIMIX (East Africa) and Famix (Ethiopia)
• Supplementary and therapeutic blended foods, which are used for the rehabilitation of the moderately
and severely malnourished.

Blended foods should be produced in accordance with:

• Guidelines on Formulated Supplementary Foods for infants and young children,
FAO Codex Alimentarius Commission (1991)
• Code of Hygienic Practice for foods for Infants and children and Code of Sound Manufacturing Practices;
of the Codex Alimentarius

The composition of blended foods should include the following ingredients:

• Cereal (sorghum, maize, wheat, millet or a combination)
• Pulses (soya beans or chickpeas)
• Oil seeds (groundnuts, sunflower, sesame) or stabilized vegetable oil
• Vitamin and mineral supplement
• Sugar (optional, up to 10 percent, replaces equivalent amount of cereal)

Blended food should be processed, using the following methods:

• Extrusion: Cereals and pulses mixed, gritted and pre-cooked through extrusion, milled
and oil/vitamins/minerals added
• Roasting/Milling: Cereals and pulses roasted, cooled , mixed and milled, then oil/vitamins and minerals added.
• The blended food should be fortified on the following basis:
1MT of finished product fortified with 1 kg vitamin premix and 3 kg mineral mix
Vitamin and mineral mix obtained from BASF or La Roche (Ltd), Switzerland, or its local authorized dealer.

Blended foods should meet the following requirements:

PROPERTY REQU IREMENT

Palatability and taste Have a pleasant smell and be food that children enjoy
Shelf life Retain above qualities for six months from date of manufacture
Preparation Be easily prepared by adding boiling water (and oil/sugar/milk if desired)
and cooked in 5–10 minutes
Moisture and fibre Have moisture content that does not exceed 10 percent; fibre content should not exceed
content 5 percent
Nutritional value 400 kcal, 15 percent energy from protein and 6 percent energy from fat (see later note on
(per 100 g) and energy vitamin/mineral specifications)
density When prepared as gruel, have not less than 100 kcal/100 ml
Packaging and Packaged in laminated woven polypropylene outer bags (double-stitched), with polyethylene
labelling inner bags (heat sealed) of 25 kg contents
Bags should be clearly labelled with manufacture date and date of expiry

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ANNEX 8:
Examples of Blended Foods with Characteristic Preparations and Micronutrient
Contents (per 100 g)
Minimum Corn-soya Indiamix Famix Tenamix
fortification blend (CSB) (India) (Ethiopia) (Tanzania)
levels (FAO/WFP (USA)
recommendations)

Ingredients Cereal, pulse, Maize, 75% wheat and Maize Pre-cooked

oil and soya flour, 25% soy; or pre-cooked, maize, soya,
vitamin/mineral soya oil, 55% wheat, soya flour, sugar, chickpea, sugar,
premix vitamin/mineral 25% soy and vitamin/mineral vitamin/mineral
premix 20% sugar mix premix
Nutritional 400 kcal, 380 kcal, 390 kcal, 402 kcal, 380 kcal,
value 15 g protein, 18 g protein, 15 g protein, 14.7 g protein, 13.3 g protein,
(per 100g) 3 g fat 6 g fat 6 g fat 7 g fat 7.4 g fat
Vitamin A 492 µg RE 510 µg RE 456 µg RE 390 µg RE 450 µg RE
1,640 I.U. 1 700 I.U. 1 521 I.U. 1 300 I.U. 1 500 I.U.

Vitamin B1 (mg) 0.128 0.7 0.6 0.1 0.3

(thiamine)

Vitamin B2 (mg) 0.45 0.5 0.6 0.4 0.5

(riboflavin)

Vitamin B3 4.8 8.0 8.0 5.0 -

(niacin) (mg)

Folate (µg) 60 - 92 50 60

Vitamin C (mg) 48 40 30 30 20

Vitamin B12 (µg) 1.2 4.0 1.0 1.0 0.3

Iron (mg) 8.0 18 13 8.0 12

Calcium (mg) 100 (calcium 800 171 100 200

carbonate)

Zinc (mg) 5.0 (zinc sulphate) 3.0 - 5.0 10

Vitamin B6 - 0.7 - - 0.4

Iodine (µg) - 50 - - 50

Magnesium (mg) - 100 - - 20

Selenium (µg) - - - 25

Potassium (mg) - 700 - 164

Adapted from Food and Nutrition Handbook. WFP, 2000.

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ANNEX 9:
Policies and Guidelines to Protect, Support and Promote Breastfeeding
and Good Infant Feeding Practices
ANNEX 9a:
Policy for Acceptance, Distribution and Use of Milk Products
in Refugee Operations (UNHCR, 1989)
The policy of the UNHCR related to the acceptance, distribution and use of milk powders in refugee settings
was developed in co-operation with WHO.
1. UNHCR will accept, supply and distribute milk products only if they can be used under strict control and
hygienic conditions (e.g. in a supervised environment for on-the-spot consumption).
2. UNHCR will accept supply and distribute milk products only when received in dry form. UNHCR will not
accept liquid or seem-liquid products, including evaporated or condensed milks.
3. UNHCR will accept, supply and distribute dried skim milk (DSM) only if it has been fortified with vitamin A.
4. UNHCR supports the principle that, in general ration programmes, protein sources such as pulses, meat or
fish are preferred to DSM. UNHCR notes that DSM pre-mixed centrally with cereal flour and sugar is useful
for feeding young children, especially if prepared with oil.
5. UNHCR will advocate the distribution of dried milk only if it has been previously mixed with suitable cereal
flour and when culturally acceptable. The sole exception to this may be where milk forms an essential part
of the traditional diet (e.g. among nomadic populations) and can be used safely.
6. UNHCR will support the policy of WHO concerning safe and appropriate infant and young child feeding, in
particular by protecting, promoting and supporting breastfeeding, and encouraging the timely and correct
use of complementary food in refugee settings.
7. UNHCR will discourage the distribution and use of breast-milk substitutes in refugee settings. When
substitutes are absolutely necessary, they will be provided with clear instructions for safe mixing, and for
feeding with a cup and spoon.
8. UNHCR will take all possible steps to actively discourage the distribution and use of infant feeding bottles
and artificial teats in refugee settings.
9. UNHCR will advocate that when donations of DSM are supplied to the refugee programmes, the specific
donors will be approached for cash contributions to be specifically earmarked for operational costs of
projects to ensure the safe use of this commodity.

ANNEX 9b:
Baby- Friendly Hospital Initiative: Ten Steps to Successful Breastfeeding
(WHO/UNICEF, 1989)
Every facility providing maternity services and care for newborn infants should:
1. Have a written breastfeeding policy that is routinely communicated to all health staff.
2. Train all health-care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within half an hour of birth.
5. Show mothers how to breast-feed and how to maintain lactation even if they should be from their infants.
6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
7. Practice rooming-in, allowing mothers and infants to remain together 24 hours a day.

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8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge
from the hospital and clinic.

ANNEX 9c:
Practical Steps to Ensure Appropriate Infant and Young Child Feeding
in Emergencies (ENN, 2001)
1. Ensure that action is based on an adequate understanding of the factors affecting infant feeding
practices in the specific situation.
• A rapid assessment should be carried out immediately at the onset of the emergency, including
information on pre-crisis infant feeding practices and the impact of prevailing conditions on infants and
on the ability of mothers to breast-feed and care for children. Where possible, information should be
accessed on demographics and numbers of infants, orphans, etc.
• A second-stage emergency assessment should be carried out in conjunction with implementation of
early relief activities. It should include mobilization of the affected population to participate in problem
identification, solution and support; assess resource requirements; and identify mechanisms to actively
involve local and international partners. The prevalence of malnutrition among infants younger than
6 months should be assessed by their inclusion in nutrition surveys.

2. Create a mechanism for coordinating and monitoring infant feeding activities.

• A lead agency should be nominated to manage infant feeding issues. A framework for action should be
agreed upon.
• Representatives of national and international agencies involved in food aid, social services and
health/nutrition should meet regularly in a specific forum to address infant feeding issues.
• Monitoring of interventions includes: (1) mortality/morbidity of infants; (2) provision of infant feeding
support; (3) procurement, distribution and end use of breast-milk substitutes or complementary foods;
and (4) quality of infant foods supplied and or/used by the affected population.
• Include infant feeding issues in initial screening for new arrivals. Information collection on number
of infants and unaccompanied infants and infant feeding practices.

3. Eliminate practices that undermine breastfeeding.

• Donations of infant formula and other breast-milk substitutes (BMS) should be systematically refused
(i.e. any requirements for BMS should be met by purchasing of supplies).
• Dried milk powder should NEVER be distributed as part of a general ration programme because of the
risk that it will be used as a BMS. Rather, it should be mixed with other food (such as blended foods) or
provided under strictly supervised wet-feeding conditions.
• Bottles and teats are should never be accepted or distributed; cups should be used instead.
• Where UHT (long-life milk) is distributed, it should be clearly labelled with an appropriate health
message.

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 4. Recognize the special needs of women feeding infants.
• Effective referral systems (e.g. registration, nutrition/health services) should be established at the outset.
• Where appropriate, provide secluded shelter areas for breastfeeding, including rest areas in transit
centres.
• Where appropriate, facilitate and prioritize access to food aid, water, etc., for women with infants and
young children.
• Provide additional fortified-food supplement for pregnant and lactating women and young children.
• Integrate support services for breastfeeding and infant feeding issues into health services,
growth-monitoring services, unaccompanied children centres and nutrition rehabilitation centres
(supplementary and therapeutic ).

5. Minimize the dangers in feeding to infants and their families.

Certain criteria are met where BMS is provided:
• Infant is assessed by a qualified nutrition or health worker to verify need.
• BMS is distributed and targeted only to infants who have an established requirement.
• The supply is continued as long as the child needs it*.
• The labels must be in a language that the mother understands and must adhere to specific labelling
requirements of the International Code of Marketing of Breastmilk Substitutes. This can be achieved
by re-labelling brand products or purchasing generically labelled products that display no company
logos or advertisements.
• The delivery of BMS to the mother is accompanied by practical information on how to safely prepare
the milk (e.g. how to cup feed, how to sterilize).
• There is no display of brand-name products.
• BMS are prepared in accordance with the relevant Codex Alimentarius standards.
• Any facility supporting mothers who are unable to breast-feed should provide separate facilities
for mothers who are breastfeeding and those who are using BMS.
• Procurement of small amounts of generic BMS (by designated agency) should be made available
for specific cases in need.

6. Increase awareness and knowledge about the benefits of breastfeeding among all
stakeholders in the emergency situation.
• Expertise should be available as resource for emergency agency staff to gain better understanding good
practice in infant feeding and to assist agencies in developing strategies to develop good practice.
• Ensure that expertise (preferably national) is available to train health workers and community-based
staff in breastfeeding and infant feeding issues to ensure that consistent and well-informed advice is
given.
• Breastfeeding promotion via health workers and via radio and other media.

* An infant’s nutritional needs will be met during the first six months of life with an average daily ration of approximately 110 g or 3.3 kg per
month, of a bona fide infant formula.

Source: Adapted from GIFA/IBFAN/UNICEF/UNHCR/WFP/WHO Infant and Young Child Feeding in Emergencies. Operational Guidance for Emergency
Relief Staff and Programme Managers. Interagency Working Group on Infant and Young Child Feeding in Emergencies. ENN. November 2001.

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 ANNEX 10:
Calculated Amounts of Basic Mixes of Staples and Protein-Rich Foods for Complementary Foods
The purpose of the table is to provide guidelines for the preparation of suitable complementary foods for older infants (> 6 months) and young children (<than 2 years old) using food-aid
commodities in combination with locally available foods. The procurement of commercially available foods should be actively discouraged.

Complementary foods should be prepared using four basic ingredients, including:

(1) cereals or tubers; (2) protein supplement; (3) vitamin and mineral supplement; and (4) energy supplement.

• The basic mixes have been calculated to give the best possible protein value. The least amount of protein food is used to supplement the staple to provide the basis of a meal for a child of about 2 years of age.
• To each of these mixes (shown in table below), add 10 g of oil or 5 g of oil and 10 g of sugar, OR 20 g of sugar should be added as the energy supplement.
• Each mix provides about 350 kcal (approximately one-third of the daily needs of a 2-year-old child).
• To each of these mixes (shown in table below), 20–30 g of fresh vegetables/fruit should be added as a mineral and vitamin supplement.
• The volumes of most of the basic mixes are between 200–300 ml when the water absorbed by the food is taken into account.

Protein Staples (g) - denoted by upper figure

Supplement (g)
Denoted by Wheat Sorghum Sweet Cassava
Oats Rice Maize (flour) Potato Yam Banana Plantain
(flour) millet (flour) potato flour

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lower figure
Legumes 75 80 65 75 55 320 125 165 105 85 40
(e.g. lentils) 5 10 25 10 35 20 50 40 55 55 55
Soybeans 60 60 55 55 50 250 150 175 140 115 50
10 15 20 15 25 20 25 20 25 30 30
Dried skim milk 65 65 60 60 60 280 175 190 165 150 60
5 10 15 15 15 15 20 15 20 20 20
Dried whole milk 55 55 45 45 40 220 100 115 100 90 35
10 15 25 25 25 20 30 30 30 30 30
Chicken/ meat 65 65 65 65 65 300 180 210 185 160 70
10 20 25 25 35 25 35 35 40 45 45
Fish (fresh) 65 70 70 70 70 310 210 240 210 180 75
15 30 25 25 20 25 35 35 40 45 50
Egg 65 65 60 60 65 300 180 220 190 150 60
10 25 30 30 25 25 35 25 30 45 50
Source: Adapted from Cameron, M. & Hofvander, Y. Manual on Feeding Infants and Young Children, Third Edition.
ANNEX 11:
Nutritional requirements for Pregnant and Lactating Women
in Developing Countries
Additional requirements (per day)

Pregnant women Lactating mothers

Total energya (kcal) 285 kcal 500 kcal

Macronutrients

Proteina (g)
Mixed cereal/pulse diet 7.1 g 18.9 g (for first six months)

Energy from fatb (%) At least 20 percent (20-25 percent) of energy should be derived from fats.

Additional requirements of fats The overall energy of breast milk

development throughout nine months may be supplied by any source, but
for fat storage and foetal. Of most the essential fatty acid component
importance is the provision of linoleic is fully dependent on fat in the diet
acid for the foetal development. and maternal stores.

Micronutrientsc

Vitamin A (µg RE) 100 350

Vitamin D (µg) 7.5 7.5

Vitamin B1/thiamine (mg) 0.1 0.2

Vitamin B2/riboflavin (mg) 0.1 0.3

Niacin (mg) 1.1 2.7

Folic acid (µg) 250 100

Vitamin B12 (µg) 0.4 0.3

Ascorbic acid (mg) 20 20

Calcium (g) 0.6-0.7 0.6-0.7

Iron: low 5-9% (mg) 60-120 17

Iodine (µg) 50 50

a: Adapted from Energy and Protein Requirements. Report of a Joint FAO/WHO/UNU Expert Consultation. Geneva, WHO, 1985 (Technical Report Series, No. 724).
b: Adapted from Fats and oils in Human Nutrition. Report of a Joint FAO/WHO Expert Consultation. Rome FAO, 1994 (FAO Food and Nutrition Paper 57).
c: Adapted from Tables A1.6 and A1.7, pages 146–147 in “The management of nutrition in major emergencies.” WHO, UNHCR, IFRC, WFP. Geneva, WHO, 2000.

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ANNEX 12:
Conceptual Framework

Causes of Child Malnutrition

Child malnutrition,
death and disability Outcome

Inadequate Immediate
Disease
dietary intake causes

inadequate Underlying
Poor water/sanitation
Insufficient access maternal and causes at
and inadequate
to food child-care household/
health services
practices family level

Quantity and quality of actual

resources - human, economic
Inadequate and/or
inappropriate and organizational - and the
knowledge and way they are controlled
Basic
discriminatory
attitudes limit household causes
access to actual resources at societal
level

Potential resources: environment, technology, people

Political, cultural,
religious, economic and
social systems, including women’s
status, limit the utilization of
potential resources
Source: The State of the World’s Children, UNICEF, 1998

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